>> the health service board meeting will now come to order. i would like to turn this over to our director now for some opening remarks regarding the present situation. >> good afternoon and thank you for joining the health service board virtual meeting with us

this afternoon. during the declared covid-19 health emergency and authorized by state and local authorities, the health service board public meeting is being held using teleconference technology which provides access for member participation online, thus producing a virtual public meeting in lieu of an in-person meeting. this virtual board meeting ensures safe distancing and safeguards the health service board commissioners, the health service system staff and members of the public. i wish to thank all the people who have worked many hours to make this meeting possible. please note that our board secretary natalie ekberg and many of the commission secretaries across the city have collaborated to learn about these meetings. i also wish to note that our internal team has worked behind the scenes to provide the technical support, including marina co-ridge, brian rodriguez

and others have stepped in to help manage our public comments today. i want to share my gratitude and thanks to all of you, as well as the health service staff who have helped make this meeting a reality. and finally i'd also like to acknowledge the city's department and technology staff of government tv for their time and energy into preparing our team. the staff and board commissioners appreciate all of your dedicated work, and i would like the board secretary to share her remarks regarding how to conduct ourselves in this public meeting in a virtual setting. thank you. >> thank you very much, executive director yent. today the health service board meeting is being televised by sf gov tv. for those of you watching the live stream, please be aware that there is a time lag between the actual meeting and what the members of the public are seeing through the sf gov tv platform. if you are watching this via the

sf gov tv platform and you wish to comment, please call into our conference line when that item is called. again, please call into the conference line when the item is called on the agenda. and press 1, 0 to be added to the conference queue. for members who would like to make public comment, the phone number to use is 888-808-6929, and the access code is 5540616. this information will be provided to you throughout the presentation, after every agenda item there will be a public comment slide produced and shown so you can see these exact instructions to dial in and to get yourself in the queue. please make sure when you do dial in that you're in a quiet location. please turn off any tvs or radios, and if you're livestreaming the meeting via sf gov tv, that you mute the sound on that particular device, if

it's a phone, laptop or ipad. this will reduce any reverberations and noise so the board members and myself can hear you. you will have three minutes to make public comment. at the end of that public comment and the three-minute timer goes off, you will be muted and the next caller will be called. at the appropriate time during public comment, the chair will ask for the phone lines to be opened and there will be a 30-second pause to allow for catch-up from the members watching this at home from what was presented. if you wish to participate and comment on a particular item, again, please dial into the phone line and promptly press 1, 0. this will add you to the line and keep you in the order that you pressed 1, 0. the auto prompt will say to you on the phone lines that callers are entering question and answer mode. this is actually during -- going to happen during public comment. you will be queued up in the order in which you pressed 1, 0. just another reminder. and there will be an automated voice which tells you when it's

your turn to speak. when your microphone has been unmuted, you will hear us ask you to state your name and to make your comments. i want to make a note that you do not have to state your name. you can remain anonymous if you wish. i will start your three-minute timer as soon as you begin talking. i will also say 30 seconds when you have 30 seconds remaining. when your time is up, you will hear a chime in the background and i will say thank you to the moderator and ask for the next caller. at that point, the moderator will put you back on mute and we will move to the next person. thank you so much for participating with us today, and president breslin, this concludes my presentation on public comment. we can move to the next geagend item. roll call. president karen breslin? >> present. >> commissioner vice-president stephen follansbee? >> present.

>> commissioner mary hao? >> present. >> commissioner wilfredo lim? wilfredo, you may be on mute if you are on the call. i will come back. commissioner randy scott? is also expected. and if you called in, randy, you have to push star 6, please. >> present. i'm present. >> thank you. commissioner chris canning? >> i'm here. >> thank you. and supervisor dean preston? >> present. >> thank you. we have a quorum. president breslin, if you are muted, we do have a quorum and we can move to the next item. >> president breslin: oh, sorry about that. item no. 3, please.

>> item three is the approval with possible modifications of the minutes of the meeting set forth below, regular meeting minutes from march 12, 2020. >> president breslin: does anyone have corrections to the meeting? hearing none, i would ask for a motion to approve. >> commissioner canning: this is commissioner canning. i motion and move that we approve the march meeting minutes. >> commissioner scott: this is commissioner randy scott. i second. >> president breslin: all right. is there any public comment on this item?

>> we will now begin public comment for the item. we will have a few moments to wait while members populate the queue via the conference phone line. once you are on the phone line, please press 1, 0 so you will be added to the queue. moderator, will you please open up the phone line for the first caller? >> the conference is now in question and answer mode. to summon each question, press one, then zero. you have three questions remaining. >> [indiscernible] public comments regarding approval of [indiscernible]. >> hello, good afternoon. we are on agenda item no. 3, which is the approval of the march 12, 2020 board meeting minutes. can i ask who we are speaking

to? >> derek cam. >> and do you have comments on the board meeting minutes? >> no, i'm just wondering if -- questions regarding the policy or the actual policy of the meeting, because i'm in regards to potential health care increases, and i'm wondering what item that is. >> all right, yes, you'll have to wait until we get to the renewal portion of the meeting. we are currently asking for callers to call in regarding the board meeting minutes. >> okay, sorry. >> no problem. thank you. moderator, can we have the next caller, please? >> you have two questions remaining. >> hi, i'm also waiting for the period where we talk about co-pays. >> okay, no problem. you can dial back in when we get to that agenda item.

>> okay, can i wait on the line? >> that is true, you can also wait on the line, yes, and then you have to dial 1, 0 again when we get to that item. >> okay, thanks. >> no problem. >> moderator, can we have the next caller, please? >> you have one question remaining. >> hello, good afternoon. you are on the public comment line. >> yes. [indiscernible] because i don't want the co-payment to be increased. that's all. >> yes, you can stay on this conference line. that's not a problem. we are currently approving the board meeting minutes from march 12, 2020. so if you don't mind, we will disconnect this public comment and you can dial 1, 0 when we get to the item number that you're interested in commenting on. >> okay, thank you. >> no problem.

thank you. >> moderator, can we move to the next caller, please. >> you have zero questions remaining. >> president breslin, we are concluding the public comment section for this item. >> president breslin: okay, the minutes of the march 12, 2020, meeting have been moved and seconded. all those in favor? >> aye. >> aye. >> aye. >> aye. >> aye. >> aye. >> president breslin: is there anyone opposed? it's unanimous. all right, item no. 4, please. >> item no. 4 is the president's report. this report is given by president breslin.

>> president breslin: all right. on behalf of the health service board and san francisco health service system, i would like to announce the san francisco controller ben rosefield's reappointment of randy scott to the health service board. commissioner scott's new five-year term will begin on may 15, 2020, through may 15, 2025. the san francisco health service system and the health service board would like to thank the controller for his reappointment of commissioner scott. commissioner scott has been an articulate and respected voice on the health service board since 2010. he has provided excellent leadership in several areas, including governance, policy while serving as a committee chair. he continues to strengthen the advocacy and the morale of the board with every year of service. thank you, commissioner scott, for all your work and we look forward to having you on the health service board for the next five years. and secondly, i would like to

announce that mayor london breed has repointed dr. stephen follansbee to the board. he has served since 2015 as a retired practicing physician. dr. follansbee has provided great insight into some of the more complex issues and questions that have come before the board. dr. follansbee has also served on the budget and finance committee. he is also serving as the vice-president of the health service board. we are grateful that you will be serving another term on the board. and third, today is commissioner lim's last meeting. serving on the health service board is one of the most challenging and complex volunteer roles. throughout your ten years of service on the health service board, you have consistently performed your duties with diligence. you are very knowledgeable of the san francisco city processes and have always advocated in

protecting [indiscernible] of the health service system trust fund. commissioner lim has also served our members in the following capacities: health service board vice-president, finance and budget committee and chair, governance committee chair and rules committee member. commissioner lim, the san francisco health service system staff, our members, all four employers, the city unified school district, community college and along with the health service board would like to thank you for your service. we wish you well in your future endeavours. with that, i will move through the director's report, please. >> karen, we have public comment first. >> president breslin: oh, i'm sorry. public comment. public comment on this item. >> and we'll wait 30 seconds before we start that. if you have any public comment on this item, please dial into the conference line and press 1,

0 to discuss the content of the president's report. >> madam secretary: moderator, we will now begin the public comment for this item. and there will be silence while you're on the conference line waiting for the members to populate your queue. moderator, please open up the phone line for the first caller. >> you have three questions remaining. >> so my name is francisco da

costa, and . . . >> sir, if you're on the conference line, we cannot hear you. can you please speak into your phone? >> and so i listened to you all from time to time, and you know that we are in dire straits because of this pandemic, and i would suggest . . . >> sir, we cannot hear you -- >> i can hear myself.

>> sir, if you're still on the line can you please try again to speak into the phone. >> okay, so i did say that we are in a pandemic and we are in dire straits and . . . okay, fine. >> madam secretary: hello, sir. are you still on the line? sir? all right, moderator, can we please go to the next caller? >> you have three questions remaining.

>> it's very hard to [indiscernible] with the delayed feed and so i'm hearing that. i would like to say welcome again to randy scott and to dr. follansbee. we are very happy that they have both been repointed to the board, and thank you very much to -- for all of his service over his terms. he has represented members very well both -- and retired and we wish him well in the future, and we just want to say thank you [indiscernible] i'm not going to miss him. i'm going to see him every time i go past his house in and out of the neighborhood, so definitely thank you, thank you, thank you, willy. you are so appreciated. i know it's also greatly appreciated by local 21 sgiu tenderloin and all of the other

active [indiscernible] and everyone you've represented in your term. thank you so much, and that's the end of my comment for now. >> thank you very much. moderator, can we have the next caller, please? >> you have two questions remaining. >> hi, i'm a registered nurse at san francisco general hospital, and my comment is a comment, not a question, and i would just like to say this is the worst possible time for you to be raising the rates and raising co-pays. we need access to health care now more than ever, up to 20% of the people that are dying from this coronavirus are health care workers, and we need to keep rates reasonable. this is not a time to raise

them. thank you. >> thank you very much. moderator, can we have the next caller, please? >> you have one question remaining. >> yes, my name is richard glassman, and how am i do not see on the agenda general comments? it's usually at the beginning of the meeting. when can people make general public comment? i don't see this on the agenda and i want to know why it was taken off or not put on. how are people supposed to speak to the commission on items not on the agenda but under their authority? and why was it left off? and when will i get a chance to talk about my issues?

>> mr. rothman, are you still on the phone? >> yes. >> we can -- i can discuss this with you further offline. if you have any comments to give during the president's report or any other item that are related to your concerns, please feel free to dial back in and make those comments under those items. >> well, they're not under any items. it's under general comments. this isn't under any item on the agenda. why was it taken off? i don't want to speak offline. i want the commissioners to hear me. there's no place on the agenda for them to hear me. why did they take that off the agenda? >> mr. rothman, this is the executive director. we have been -- this is our first virtual meeting, and we were trying to make the meeting concise so that we could get

through the business at hand. i apologize if that puts you in an awkward position. you are welcome to make your comment at this time or later in the meeting. >> well, i'll make it this time because it's not under the item. i'll be short. one was a smile. next month delta dental is going to make a presentation, and i ask that they make a detailed presentation of the smile program because i sure don't understand it, so [indiscernible] will make a detailed presentation in what's covered under the maximum and what's not covered. i kept getting different stories. and as far as kaiser, i'll wait until next month. the only thing i want to say is i think we should set up an

advisory committee to deal with issues that i've gone through and some of the other people, and the people i talk to at kaiser feel that this would be a good idea, and i hope the staff and the commission would agree that we could set up an advisory board made up of kaiser members and act [indiscernible] so we could deal with some of the issues that crop up. thank you for letting me speak. >> madam secretary: thank you very much. moderator, can we have the next caller, please. >> you have two questions remaining. >> hi. i don't have a question but i have a comment. i'm a registered nurse. i just want to leave a comment about kaiser distributing [indiscernible] masks. right now we're finding this

pandemic and we don't know what kind of modes of transition this virus is going through. there's a lot of nurses dying, and we nurses in south san francisco have the highest, you know, in the region of positives -- nurses who are positive for covid. and bringing to the cdc reprocessed masks are not [indiscernible] decontaminating the masks are not a sure way of protecting us from the virus, and even the sva is saying that [indiscernible] kaiser is using a company to re-process the masks, they have never been cleared or approved for the decontamination process. and so kaiser has not been

transparent about how they are managing the situation or what number of [indiscernible] they have in their stockpile. so why don't they follow ucff, you know, allow us to use the new masks and then save the ones that will be surplus at the end. instead of saving it for the future, like what they're saying, there will be no need because all of the nurses will be dead. so i'm invoking the board of supervisors to please put pressure on kaiser, especially when they ask for rate increase, you know, to give the nurses and front-line workers the protection we need in order for us to take care of our patients. because we as caregivers, we are not safe, and our patients will not be safe. we go out in the public, we will not be safe. we will be vectors of the virus,

and so i ask your committee, your commission to please put pressure on kaiser. [indiscernible] at this time of pandemic they will increase their rates. that's inhumane, and now more than ever our health care workers and front-line staff need the -- >> you have 30 seconds remaining. >> and they need all the help they can have to be given in order for them to be given the protection and the health care that they need in this pandemic. thank you so much. >> madam secretary: thank you. also, anyone else who is still in the queue to make comments under the president's report, the kaiser item will be called. it's item no. -- let me go down in my agenda, please. it's item no. 12. it's going to happen later on in the agenda, so if you are in the queue currently for public comment and plan to talk to the

kaiser item on the agenda, please note that at the beginning when your line is opened so we can move on to the next agenda item, thank you very much. moderator, can you please see if anyone else is left in the queue? >> you have two questions remaining. >> hi, i'm a behavioural health commission at the merck and i want to speak about the kaiser plans to increase the premium rate. >> hi, good afternoon. i'm going to pause you right there. we are going to call this item later in the agenda. if there's any way we can have this comment made under the kaiser item, so we can move on to the next agenda item. >> we don't have -- i actually have to work and meet with clients, if it's possible for me to be able to share. >> go ahead, yes. i will start your timer now. >> thank you so much. i do not believe the premium rate should increase due to the pandemic. additionally, this has not been [indiscernible] and last i just

don't feel it's a good idea to put more stress on the front-line workers and their families. thank you. >> madam secretary: thank you. moderator, next caller, please. >> you have one question remaining. >> hi, i'm president of ifeti local 21, and i'm calling to thank and congratulate willy lim for his service. beyond the borders is a difficult thing to do. it's a lot of work and we really, really, really appreciate willy's work, and he will be missed. i do have comments on the kaiser, but i'll save that for the appropriate time. again, willy, thank you very much. thank you, bye. >> madam secretary: thank you, sir. moderator, is there anyone left?

all right. i believe this concludes public comment on this item. >> president breslin: all right, item no. 5, please. >> item 5 is the director's report. this report is given by the executive director, abby yent. >> good afternoon, commissioners and members of the public. thank you very much for working with us as we learn this new technology and this new way of working in the virtual world. a lot has changed since we met in march. i just want to go through the highlights in my director's report today, and first off i want to note that may is mental health awareness month. i think it's worth noting that all of us are under enormous amount of strain and stress during this shelter-in-place period in the pandemic, and so we -- i encourage all of us to

take care of our mental well-being as well as our physical well-being during this time. to that end, we did worked with mayor london breed when she announced enhanced mental health resources, that we have now rolled out for city first responders and have expanded mental health services for all of our front-line workers through our employee assistance line, which is now our three employee assistance staff members who have done a heroic job throughout this period, are now assisted by a 24/7 service that can provide needed guidance and assistance and counseling to any of us that need their services, and that's a welcome service since many of us know that these kinds of concerns and anxieties don't always come on a 9 to 5 basis, so it's great to

have 24/7 availability. we work very directly with our public safety department implementing a tool called cortico, which is a smartphone application that's designed by and for public safety workers. it's literally in the hands of the fire department, the police department, the sheriff's department and our 911 operators so that they have services available to them through their smartphone app. so do take care of yourselves as we go through this period and attend to your mental well-being as well. as i mentioned, our eap and our well-being services are really focused on these areas and have many resources up on our website. please visit it if you have not yet done so. also i will move into our department's covid-19 update. we were able to move to close our office to the public

effective march 16 with most of our workforce being able to assist remotely. we are abiding by the shelter-in-place rules, and it's been complicated. it was complicated from the get-go by the fact that we did have an archaic phone system that was not the best when we first had to shelter in place in that our members when they called us it went directly to voice mail and then we had to retrieve the voice mail and then call people back. we had around 2,000 phone calls that we did that with, but we got through all of them. on april 17, however, we finally did, with the assistance of the department of technology and our it staff within hsf converted

over to the modern digital telephone system, and that went live, and that has made member services call answering much, much easier and more direct. so our members may not even -- may not even realize the technology that goes behind that call, but it's been very beneficial, and as our board knows, it's been in progress for some years, so we're very happy to have it, have it live and in person. we are, along with all city agencies and other businesses, considering return-to-work plans. they are very complicated, and we will update you on the progresses of those plans as they become clearer to us. we are, of course, doing them with public health guidance as we can imagine the safety is important as we learn new ways of working in this pandemic that will be with us for some time. other updates in the director's

report include announcing the new company altaes that has brown and -- as part of its business model. we are anticipating we've heard from brown tollen a couple of months ago about plans that they had to stabilize their business business maddel and the altaes partnership i think is a big piece of that. we will look for the benefits of that going forward. i have included in my director's report information from blue shield of california as an update to some of the questions that we have had about the implementation of the infertility benefits. that investigation and system improvements are ongoing with that carrier. we had planned on having an in-person update in april, our april meeting was canceled. the timeline has lagged this

month, and so we are anticipating a june finalization of that report on their infertility benefits and what they've done to correct procedural difficulties that exist, had existed. i also included in -- attached to my director's report today in lieu of doing a financial report we have included the financial report in my director's report. there is an executive summary on the first page that reads as if pamela were reading it to you aloud in the boardroom. and so i want to pause there and see if there are any questions from the board regarding my director's report. as i close my remarks, though, i do want to just state publicly that our staff has been

absolutely amazing in their adaptability to this situation. they have been very, very engaged. we have continued to do all staff meetings and many special meetings using video conferencing, and i'm very grateful that our staff remained healthy and has remained very committed and dedicated to the work that we do on behalf of our members. thank you. >> commissioner canning: this is commissioner canning. i have two comments and a question related to your report, director. firstly, gratitude. i have heard from numerous members, particularly early retirees trying to navigate through the process of obtaining their medicare coverage with the effects of the pandemic, and

your staff was extremely helpful, so i wanted to thank you and your staff for all of the help you provided, especially with the current pandemic situation. secondly, another expression of gratitude for the eap benefit for mental health access to our first responders. i realize it's been rolled out, and i know that my department, the access is very much appreciated, which leads to my question about that particular benefit. there was discussion about it being available to retirees as well. is that a component of that benefit that you're aware of? >> yes, it is, and it's uniquely so with this particular application because the application is very much coordinated by the department itself. so as you certainly appreciate, being a member of the police

department, when someone leaves the force, they are still sort of considered family, if you will. so it is up to the department to determine who they grant access to or as to how they promote the availability of the application. so it is up to the department, and that makes it pretty unique. >> commissioner canning: thank you very much, and i assume that is the same for each department with access to the benefit for their retirees? >> yes, and i can't say for certain at this moment that we've done a concerted effort to make that known. we really pushed us and corticoto the limits in bringing this online for four departments in less than a month. and a lot of kudos goes to our well-being team who helped coordinate that. but that's a good check-in point to see how we're doing with the

rollout and engagement of early retirees. >> commissioner canning: thank you so much, director. those are my comments and question. again, thank you to you and your staff. >> commissioner follansbee: this is commissioner follansbee. when i went through the agenda items, i had some questions regarding the infertility statement provided by blue shield of california, the update. some of those issues were, in fact, addressed. and i thought that was going to be re-posted, the clarification for some of the items, such as the definition of sme and also bullet point five, which dealt with the 17 cases that require additional review. so is that report, the response to that, those concerns, available or is that going to be held until the verbal report? i'm confused. >> yes, we did talk about that.

i didn't include it in my update, but the s.m.e., first of all, the subject-matter expert, kind of insider baseball talk, i apologize for that, and then the cases themselves are -- i can't remember the answer to that question, off the top of my head. but i know that case review is still being completed, and that will be summarized and reported out in june. >> commissioner follansbee: my recollection on the response to the question on bullet item five was that the blue shield of california reviewed all 17 denials in the calendar years '18 and '19. the 17 cases that required additional review were the ones that were denied, and there were several that the issues were not covered in the current benefits, and so that left -- and some

other issues around coverage, so that left the eight that required additional claims review. that is being done, my understanding is, by the s.m.e., and we didn't have a preliminary report on those eight, and we will hear that i guess in the follow-up next month? >> correct. correct, and i think what you're describing is certainly the complexity of doing this kind of review and, yes, i think we will have the answers at our june meeting. >> commissioner follansbee: my understanding is that it's one person doing -- who is acting as s.m.e. and then that person is doing the reviews, and again, we'll get much more detail on all aspects of this review. >> yeah, and it requires an enormous amount of outreach to the member as well as the providers to get a full picture on what occurred and if there were issues and how to correct

them. >> commissioner follansbee: thank you very much. >> supervisor preston: this is supervisor dean preston, and thank you, director yent, for the director's report, and i also want to thank you and your team for all of your work during this very challenging time and also to all the folks who have made us going online here possible and are making it possible today. i just wanted to echo dr. follansbee's, some of his comments and concerns, and appreciate the work that's been done around getting to the bottom of the infertility issues, and i realize as a newer commissioner this has been going on for a while trying to get a clear path forward and get some answers, so i'm pleased that we're going to be getting a more complete report. look forward to that in june, and thank you for all your work on that. i did want to ask, there was -- i saw a reference to a request

from public records around this issue. i realize that those can be very challenging right now, but i wasn't sure if there's any status update on whether there's any public records to actually request pending or anything. i know someone has done quite a bit of advocacy around this issue. i appreciate her work and other advocates for surfacing this. i just wanted to check in on the status of responding to any public record requests on this issue. >> yes, we are certainly in receipt of that request and have been working to call down the information that was initially requested. i think we had a 10 gigabyte load of information that could not be accessed remotely, and so we do have one or two members of the management team going in one or two days a week, into the office, which is for essential

services, and so that has fallen under that, but it's going a little bit slower than we would normally process because we had to take -- because it had to be done -- a, it has to be done in the office. b, it was a full load and we had to revisit on numerous occasions the algorithms to get to the information that would be made publicly available. we do manage a lot of phis, so we have to be extraordinarily careful when we process these kinds of requests. so we are on track, as i understand it, to have that completed this week. >> supervisor preston: great, thanks so much for the update. i appreciate it. >> you're welcome. >> president breslin: so is there anyone else from the board? if not, i will ask for public comment.

public comment on item no. 5. >> madam secretary: yes, i'm just waiting a few moments to see if anyone's going to join the queue, and then i will call for it. >> president breslin: okay, sorry. >> madam secretary: we will now begin the public comment for this item. there will be silence while we wait for the members to populate the queue. i would also like to remind those calling in on this item that this section of public comment is on the director's report content specifically. if you have any other comments on other items, please hold and either drop off the line and call back in when your item is called, and that will happen

later in the meeting. we want to keep the agenda moving forward, and as this is being broadcasted to keep within our time frame. thank you for your understanding. moderator, will you please open up the phone line for our first caller? >> you have two questions remaining. >> hello, quick question to the director, i see that the finance report that is attached is from february, and i was trying to listen very carefully, and i may have missed it. are we going to have a more updated, like to end of march or end of april finances, or are we waiting until later? i'm reading your comments about a quarterly report coming. are we going to see more -- a more updated finance report soon? or did i have the wrong finance report attached to the documents that were available to download?

thank you. >> claire, as i understand it, our month end close allows us to report a bit in arrears. not as current as one would think. so when we prepare this report, we're preparing it on the close of the month, which for february -- so i don't know if pamela can help me out here if she's on the call, but i believe what we put together is the latest available reportable data because it has to be closed out before we can report it. >> this is pamela levin. deputy director, chief financial officer. yes, we have to go in arrears because labor and some of the revenues aren't actually finalized in the month they occur until the following month,

and so, yes, we will provide more updated information when we have our next meeting. >> thank you, and happy retirement, pamela. >> madam secretary: moderator, can we have the next caller, please. >> you have one question remaining. >> hi, good afternoon, commissioners. my name is theresa rutherford. i am one of the vice-presidents of [indiscernible] ten to one, and i just want to make a brief comment here. we are not in agreement with any increase in rates or co-pays by any health providers at this time. it is clear to sgiu and public

unions that kaiser [indiscernible] large [indiscernible] profiting off the pandemic and front-line workers who are risking their lives. we are, therefore, asking the commission to stand up with unions and with all the front-line workers and to fight the corporate greed and the abuse of front-line workers and the public. if health care workers are not protected, the public is not protected. we are all at risk. please do not support any increase in rates or co-pays at this time. please do your part as commissioners to protect workers and the public in this pandemic. we talk about an n-95, that is a barrier. you are our barrier against these big corporate organizations who are making hand over fist money. do not allow it. do not support it. do not allow any increases at

this time. it is going to hurt us. it is going to hurt you. it is going to hurt this entire country. health care workers who have to struggle to pay co-pays and to look after their families will not be able to focus on these important things [indiscernible] every one of you there sitting on that commission, your family's at risk as much as all of us. so please make that decision today and moving forward not to allow big companies to make -- >> miss, you have 30 seconds remaining. >> thank you. i'm done. >> madam secretary: president breslin, i believe we have

concluded public comment on this item. >> president breslin: okay. very good. now we are into our rates and benefits section. and i would ask you to -- now that i'm in this section, i think it might be a good idea, if there's no objection, to move no. 12 to the end of the agenda. it seems like there's going to be a lot of questions on that item, and i don't -- i think some of the members might not be clear on what was really presented there. so we do need to get through this because it is our rates and benefits, and we want to make sure everybody does have a health plan next year. so with that, i would ask for no. 8 -- no. 6, please. >> madam secretary: no. 6, item six is the presentation of the 2020 rates and benefits calendar for plan year 2021. this is presented by the

executive director. >> good afternoon, commissioners. the updated rates and benefits calendar is available in your packet. we are coming to the end of our rates and benefits cycle. today before us are the three medical plans and several other items for action, and then in june we will be hearing the medicare plans and the dental plans. are there any questions? >> commissioner scott: this is commissioner scott. are we planning to have this meeting on the 28th? >> of this month? >> commissioner scott: yes. >> that is still on hold. it depends on how things go here today. >> commissioner scott: all right, thank you.

>> madam secretary: president breslin, you are muted if you are trying to speak. >> president breslin: i should leave that thing. anyway, yes, public comment on this item, please. this was item no. 6. >> madam secretary: that is correct. we will wait a few moments for the queue to populate and then we will begin with the asking of that opening of the line.

we will now begin the public comment for this item. callers, there will be silence while we wait for other members to populate the queue. again, i want to remind everyone that's on the call line, this is for all public comment regarding the rates and benefits calendar, item no. 6 on the agenda for today. so if we can please keep our comments focused on the rates and benefits calendar, that would be very helpful to keep the meeting moving along. moderator, can you please open up the phone line for our first caller. >> you have three questions remaining. >> hello. i'm calling on the benefits and rate plan. [indiscernibl

[indiscernible]. >> miss, your connection is cutting out. can you please start over for us so you we can hear what you have to say, please. >> yes, i'm saying that as a health care worker too for my salary i can barely afford $20 for a co-pay. so will the co-pay increase? or will the amount that they are taking out of your cheque increase? [indiscernible] hello? >> yes, miss, your phone is cutting out. we can only hear part of what

you're saying, if you want to continue. hello? >> yes, hello, can you hear me now? >> madam secretary: yes, i can. go ahead. >> i wanted to know if the $20 co-payment is going up or is it the fee that they are going to take out of our cheque every two weeks? >> madam secretary: so, miss, this time is for public comment. i cannot answer any of the questions that you're posing at this time. if you have any comments on the rates and benefits calendar that was just presented by the executive director, we can take those comments now. >> okay, so that's my comment. my comment was that i could barely afford it on my income, so i'm just saying that, you know, health workers don't make that much money, so i was just wondering if they were going to raise the rates for the co-pays, but there's no -- if you can just make comments and there's no, you know, questions and

answers at this time, then i guess that's it for me. >> madam secretary: all right, thank you very much. we appreciate the comment. thank you. moderator, before we open up the line, i want to remind callers who are in the queue, this particular item is on the rates and benefits calendar that we just presented regarding what is coming up on future agendas for june. if you have any comments on any other item, please drop off the line and call back in during that item so we can move on to the next item of your agenda. thank you very much. and, moderator, can you please call the next caller. >> you have five questions remaining. >> hello, i am calling in regards to -- actually, i was [indiscernible] president of our

chapter. i just want to thank the health service board for your attention. we like to take the time to provide the details that it's so important that we're concerned against the recommendations of medical co-pay rate increases for any medical benefit program. in light of the covid-19 pandemic and the major impacts to workers and the community, it has costs such as furlough, shelter in place, telecommuting, the dangers of still having to work in the office or [indiscernible] sites [indiscernible] or the [indiscernible], the need to sterilize offices, office locations daily, the stem of the public following the directive causing many to be infected [indiscernible] while maintaining distancing from staff and clients and the

possible issues of layoffs in the future. we do not have time to wait for you guys to do a single pay.

>> thank you, your time is up and thank you so much. >> natalie? >> yes, president. >> and board members, i think that we will have to lim limit e public comments to one minute because most of these comments are not relevant to the particular agenda item and, job we have a lot of things to go through here.

>> next caller, please. >> i'm against this and are you trying to take this increase out of my paycheck. paycheck. >> moderator. >> operator: you have four questions remaining. >> hi. i don't have a question. i have a comment, as well. i think the majority of the working people working, i'm surprised they're bringing this up right now, to decrease the

co-petecopay, this is really ous and i have to words to explain how we already feel as it is. and for you guys to be voting on something at this time in this crisis right now, we don't need the extra stress. we're already stressed to the max and the economic system is very bad and will get worse. i would appreciate that you take this particular conversation -- >> i'm sorry, miss, your time is up and thank you for calling in. >> thank you. >> moderator, open up the phone line, please. >> operator: you have three questions remaining.

>> i'm a 1021 local union member and to address the hs committee and it was like, no, we're dealing with too much as it is and for anyone to think about increasing our medical. we're struggling enough as it is. and that's all i have to say. thank you. >> thank you. moderator, next caller, please. >> operator: you have two questionings remaining.

>> yes, i am working for hsa and i was shocked that the medical payment increased. i just feel that during this pandemic, it's not supposed to be increased because i see a lot of people getting laid off and they are very stressed, so my comment is, to vote no for this medical payment increase, so please rely on commissioner to help out to support this medical copayment, not to increase. thank you. >> thank you. moderator, can we please take next call.

>> operator: you have one question remaining. >> thank you for your time, everybody. i really appreciate it. i work at 1440 harrison street where we are constantly under pressure because we want to help out our clients. wplease, we don't want to incur another copayment increase. thank you very much for your time. >> to thanthank you very much, . >> moderator, is there anyone left on the line? >> you have zero questions remaining. >> thank you very much. this concludes public comment on item number 6, president.

>> as for item number 7, i'm not so sure i needed a motion to change public comment to one minute instead three. i know i've seen it done at other meetings. does anyone know if i need to do a motion for that? >> let's just do it, karen. there's no harm in doing it. >> i've seen it did at other public meetings, but i don't recall them doing a public motion. >> this is commissioner scott and i would say that if we're in the middle of a discussion item, that it seems to be a little bit off-balance, in the middle of that item and in the middle of that public comment to cut the time down, but i would say going forward as we proceed with this meeting, i would absolutely concur that we need to restrict

public comment. >> madam president, i just wanted to ask related to this, and just in terms of the order of hearing things, it seems we have a lot of folks calling in presumably on item 12 and i wonder if instead of limiting the public comment time, we might want to consider hearing item 12 sooner. i understand that's maybe the more controversial and longer one, but it seems we have a lot of folks on the line watching who want to address that particular item. and i think as we keep calling the earlier agenda items, we'll keep hearing from folks on that one. so rather limiting public comment time, perhaps we would want to take item 12 out of order and have folks speak to that item.

>> how do the other commissioners feel about that? we have a lot of things to take care of. so that could take up an hour of our meeting. so how do the other commissioners feel about that? >> i think we need to understand our remind ourselves about the time-table under this agenda item. this has to go back to the board of supervisors at the end of june and i do think that if we are going to hold a discussion or recommend an alternative to any of the rates and benefit's calendar items, because we have heard some addressing one health plan and others addressing all of the health plans that we're considering today, then if we

were to vote to hold the rates and benefits static for 2021, we wouldn't able to do that. we would have to go back to each of the health plans so we could hear what kind of services would be cut in order to accomplish that. and that's a point of negotiation from my standpoint. so i would want to hear more of a comment on that before moving forward. because even if we move one agenda item forward, i think some of the comments have addressed all of the increases proposed to rates and benefits for all of the the different dih plans. >> so this is commissioner lynn and i agree with supervisor preston, i think, because if we move to item 7, 8, all of the comments will be related to item number 12 and holding up a lot of these items. so moving off of item number 12, hopefully when we go back to

item 7 up to 11, most of the comments, most for item 12 will be done. so i agree to move item 12 right up before item 7. >> well, any other comments? any other comments from the director o? >> you know, i think it's six one and a half dozen of the other because i've seen many of the communications come through earlier today and the messages are all similar and the public wants to speak. i think if we call the kaiser question now and let folks speak, i know you're considering limiting the comment to one minute, which would give us the

opportunity to accommodate more callers because i know they don't want to sit on the phone either and that might be a good solution and we'll see how it goes. >> ok, so are we going to move item number 12 up to our next agenda item instead of item number 7? is this a consensus and we limit the public comment to one minute? >> this is commissioner canning and one quick question. i think we should make a motion. dr. gant, moving item number 12, will the change in sequence affect the ability for us to understand the concepts that are likely involved in the previous five items on the agenda? if not, then i think there shouldn't be an issue with moving it forward. >> commissioner, i think your point is well taken and that we

have an overview of the medical plans that we could and it's not an action item but to set the table for hearing the medical plan. we could defer and go directly into the plans and do kaiser first. >> this is commissioner howl anl and i agree. if we can take item 10 for the overview and then possibly take the kaiser item after that, i think that would give us a better context. >> supervisor preston and i agree. >> this is commissioner kenning and we should hear item 10 first and then go into 12.

so with that in mind, i would like to move that at the conclusion of this current item that we move item 10 on the agenda for an overall review and then after item 10, go directly, then, to item 12. >> this is commissioner scott and i second that motion. >> ok. >> we making point comment one minute for the remainder of the meeting? >> yes, of course. i'm just asking, do we need public comment after this

motion, which is usually what we have to do? >> this is supervisor preston and i defer to the other long-standing members that i'm not sure in terms of reorganizing the timing of the agenda that that requires a motion and i think that would be at the discretion of the president unless there's a unique rule on that that would require a motion. >> ok. then i am gobbin going to recomd that we take item 10 next on the agenda and after that, we will take item number 12 and, also, i'm recommending that we do one minute. so then we can go forward now, unless anybody has another objection. >> this is commissioner kenning and just for the record, i'll

withdraw my motion. >> very good, thank you. natalie, go ahead. item number 10, leads. please. >> i'll ask my producer to move forward to the item 10 slide. and then madam president, i'm going to wait about 30 seconds for the live tv foo feed to catp to what we're doing. >> ok. out of order, there's item number 10 -- my apolog apologie, there's plan year for 2021 by

mike clark from aon. >> good afternoon, everybody. i'm mark clark, actuary from aon. before i commence on this item, i want to congratulate vice president and mike scott and reappointment and commissioner lynn, congratulations for everything you've done and the entire community, thank you for your service and wishing you well in this last health service board meeting for commissioner lynn. so item number 10 is our health plan renewal summary for active employees and early retirees for the 2021 plan year and go to the next slide. so for the non-medicare plans, these are for active employees and early retirees of the san

francisco health service system and this particular presentation summarizes the renewal actions that we are about to present for each of the three major non-medicare health plans and so the cycle's renewal efforts into the 2021 plan year focused on understanding how plan costs in 2019 are impacting 2021 rating actions, as well as to enhance member support from sfhs support health partners. this table illustrates the rate change actions that are being proposed today. we show a before-rate stabilization adjustment column, which is the true actuary underwriting of the rate change for each of the four plans offered to active employees and early retirees and then because the blue shield plans and the united healthcare plans are essentially self-funded, there is a rate stabilization fund set up for the blue shield and uhc

plans and so, based on prior hsb approvals earlier in this rates and benefit's cycle this year, we applied those rate stable adjustments which we'll talk about in each of the presentations to ultimately derive the recommended increases for blue shield and uhc that you see in the right side of the table. the kaiser program is fully ensure plan and there is no rate stable adjustment for kaiser. next slide. commentary on each of the proposed rating actions that we'll be reviewing with the health service board today, for the blue shield plans, the access plus increase is 3.6% and the trio increase is 6.3%. there were lower rate increases in the 2020 plan year, approximately 20% overall and these 2021 rate increases remain

below expectations for access plus and are consistent with cost trend expectations for trio and are all derived from underwriting the 2019 health plan experience with associated fees and the programs forward to the 2021 year. for kaiser, a recommended increase of 5.1le 5.8%, followia 5.9% rate increase that applied in 2020. the increase did include 1% for the return of the affordable care act in 2020. however, that tax is being eliminated permanently by the federal government now. and so, the underlying rate increase for kaiser based on the member utilization experience in 2019 would is been 6.7%, but then removing the health insurer

tax portion results in an increase overall of 5.8%. we will in today's presentation present an alternative design renewal for health service board consideration that could potentially change two elements of kaiser plan design to match copayment levels now in the blue shield hmo plans. and then for the united healthcare ppo, commonly known as city plan, we have calculated a 0.9% aggregate increase across city plan and city plan not available which does reflect underlying trend increases from 2018 to 2019 and also reflects the portion of the rate increase 1.5% of the 9% aattributable to stabilization by upping rates and how that applies from 2020

to 2021. next slide, please. for grounding, this shows the distribution of the active employees and the early retirees in each of the medicare health plans offered b and you will se% enrollment and 49% enrollment of the early retirees. blue shield has most of the population with the city plan and city plan choice not available representing 2.5% of active employees and about 14% of early retirees and these are figures that were included in the 20 demographic's report presented to the health service board in february of 2020. mexico slide. next slide. in my final slide for this presentation shows the 2021 total monthly rates for each plan and these are shown in this

exhibit purposes to the nearest dollar. although rates are to the nearest cent, as well as how the total plan rates would distribute to employer contributions and member contributions and that is based on the city county of san francisco active employee formulas and for early retirees receiving the full city charter formula employer contributions. and you'll see in the footnotes, cpcna stands for city plan choice not available and these rates above are for a status-quo design, no-design change scenario and that concludes my presentation. >> president, breslin, to you are speaking, you are muted.

>> are there any commissioners' thoughts on this? otherwise, i'll going directly to public comment. so it looks like we go directly to public comment. >> again, as a reminder, we will be holding approximately for 30 seconds to allow callers to discuss this particular item. the medical renewal overview slides that were just presented.

we will begin public comment for item number 10, the medical renewal overview slides that mr. clark presented. this will be done in the next five or ten seconds and there will be silence while we wait for other members to populate the line queue. if you're on the line, press 1-0 to get to the cue. moderator, will you please open up the phone line for our first caller. >> operator: you have five questions remaining. >> hello. this is anna from dhs and my question is was this set up and you're voting on it now based on last year's economy, based on what happened in the last two years? because right now, this is not the time for that and for the

poor working people to get that high amount and they won't be able to pay for this. they can't pay for medications now and they won't receive the healthcare because the payments will be high. >> are you done with your public comment? >> yes. i just wanted to say that i'm a union officer and i'm against the discussions that we're having now. can we talk about it and negotiate about it? because you already made a decision that you're voting on it today and this is the first time i'm hearing about it. >> i appreciate your comment. thank you very much. >> thank you. >> moderator, the next caller, please.

>> operator: you have five questions remaining. >> thank you,. (inaudible). >> why this is 7.5% after stabilization? and i'm not sure i understood from mike's presentation why that is so high for city plan. as you see, there's a number of retirees in city plan and the number of actives diminishes significantly all of the time, but we have at least 14% and many early retirees vote into city plan for a thum number of reasons and a lot of them move out of the area. but given the situation that's going on, by the way, actives have been canceled, i

understand. and when i look at these increases, 20% for city plan seems -- >> your time is up for the public comment. thank you. >> pomoderator, the next caller, please. and i want to remind everyone this is a one-minute public comment. thank you very much. >> operator: you have five questions remaining. >> hi. my name is debbie and i'm a san francisco voter and civil servant. i implore you all to reject any and all items that increase rate for health-related benefits to public servants. we serve the public. we expose ourselves to everything. we're disaster workers and we should not have to -- of all people, we should not have any

increases to our health benefits. so i implore you to vote against any and all increases. thank you. >> thank you very much. moderator, can we have the next caller, please. >> operator: you have three questions remaining. >> hi, this is deborah grabell with local 21 and i want to make a comment about the proposed increases on kaiser and the proposed design plans on the copayments, specifically utilizing more money more hospitalized in the time of covid-19 seems outrageous and immoral, the same with outpatient surgeries. these are not things people choose to have happen to them and even though kaiser is crying for it, they made millions of

dollars and we don't think these increases should be passed on to working people in san francisco. pair operato(please stand by

we cannot afford that, and this should be an item that we all take, you know, very seriously and from working with works on the front line are those of us working at home. again, i think it should have been avoided to allow the time to be the same or those who need treatment get what they need to pay. to put it down to one minute -- >> i appreciate your comment, miss, but your time is up. thank you. >> thank you. >> madam secretary: moderator, can we have the next caller, please? >> operator: you have four questions remaining. >> hello. my question is -- this is a pretty quick turnaround for this price hike. there's no -- i have not been given any jurisdiction for this.

[indiscernible] actual doctors and staffing. that is all. >> madam secretary: thank you, sir. moderator, can we have the next caller, please. >> operator: you have four questions remaining. >> madam secretary: hello? if there is someone on the call, can you please begin your public comment? >> hi, yes, i am speaking as a resident of san francisco. given the current state of our national and local government, hiking up the costs for our most valuable health care workers is totally unacceptable. i'm asking that the health services board vote against any increases to health premiums for

our most valued workers here in san francisco. thank you. >> madam secretary: thank you very much. moderator, can we take the next caller, please. >> operator: you have four questions remaining. >> hi, yes, my name is amy. i am a mental health human specialist at the san francisco behavioural health center, and i do not agree with the increase for the co-pay for the kaiser, as well as for any insurance [indiscernible] people. again, i agree with a lot of the folks who have been calling in about the rate increases. we have to protect our front-line people, and the city and county of san francisco employees have been really diligently working hard to protect the community, and i think it's really about time to really protect the health workers, community, and keep everybody safe. so please do not, do not vote to

pass co-pays for any health premiums or co-pay with insurance company. thank you. >> madam secretary: thank you very much. moderator, can we take the next caller, please. >> operator: you have five questions remaining. >> hello. thank you so much to all of you for listening. my name is mary mcgee. i was a registered nurse with the department of public health for 32 years. i recently retired. i can't say enough good things about the staff there. i think it's one of the best-run departments in the city. i am calling because i'm deeply concerned about the possibility of rate increases. there is an article in the paper today about 3,000 city employees being deployed [indiscernible] service workers. they are being thrust into jobs they have never done before,

incredibly stressful, different shifts, different responsibilities, not a lot of direction or coordination in the midst of these chaotic times, so this is very much the last thing that workers need financially or psychologically, the increasing of rates. it will affect retirees and will -- >> madam secretary: thank you, miss, but your time is up for public comment. thank you very much. >> thank you so much. >> madam secretary: thank you. moderator, can we have the next caller, please. >> operator: you have four questions remaining. >> thank you, operator. my name is derrick stan. i'm an engineering associate, a union member and opposed to co-pay.

many businesses have had to make rapid cuts to meet the demands of the positions of sales. [indiscernible] are in positions that places them in direct potential risk all the way [indiscernible] delay. we have been uprooted, potentially placed in harm's way and now [indiscernible] during troubles times like this is neither fair nor just and that's why i oppose the idea both as a worker and as a person. again, thank you for your time. >> madam secretary: thank you so much, sir. moderator, can you please take the next caller. >> operator: you have four questions remaining. >> my name is sophia alvarez. i oppose the commission taking any moves to increase any co-pay rate increases. please listen to the nurses who are adamantly against this.

their voice [indiscernible] continued stabilized support from you against any rate insurance increases, the risks the health care members that are delivering services, your insurance companies will, of course, continue to push for rate increases. vote in the interests of the members and our community. the seniors are on fixed income. they can't afford any further increases. thank you. >> madam secretary: thank you very much, miss. moderator, will you take the next caller, please. >> operator: you have four questions remaining. >> hi, my name is john seagrave. i work for the city and county as a technical engineer with public works, and i am a union member of local 21. i'm very disturbed and concerned by any and all attempts to increase our co-pays now at this

extremely critical time in the middle of a pandemic. as a worker who depends on my employer-based health care as part of a workforce that makes it possible for the city to fight covid-19, it's concerning and alarming that i'm told that i must pay more in case i get sick in the process of helping the public during this difficult time. i oppose this increase. thank you. >> madam secretary: thank you very much, sir. moderator, can we take the next caller, please. >> operator: you have four questions remaining. >> hi, my name is aubrey karson and i work at san francisco general hospital, and i absolutely oppose any rate increases at this time. everybody is going through economic strife right now, and my family is also affected. my household's down $4,000, and i've had to pull two children out of daycare and i'm having to work 20 hours extra a week just

to financially compensate for what we're going through, deferring as many payments as possible. this couldn't have come at a worse time, and i know my family isn't the only one that's affected, but to make a decision like this would be incredibly selfish and ill timed, and that is my comment. >> madam secretary: thank you, miss, for calling in. moderator, can we take the next caller, please. >> operator: you have three questions remaining. >> hi, this is president of -- local 21, and i want to echo with regard to so many of our members and members of other labor groups and nurses that this is not the time for the rate increase or for the increase to co-pay. health care is critical at this time. this is not the time to make this kind of adjustment, and i ask the board to reconsider the motion, to vote against the motion, rather.

thank you. >> madam secretary: thank you, sir. moderator, can we take the next caller, please. >> operator: you have two questions remaining. >> hi, my name is theresa rutherford. i remember sciu 1021. i'm one of the vice-presidents, and again, we urge you to vote no against rate increases and any increasing in co-pays. as my fellow union brother said, this is not the time for this. it's san francisco. we are asking you to show the federal government, show the person in the white house what it is to lead. please lead on this. this is not the time to penalize front-line workers who are doing the work, and their families and [indiscernible] by having [indiscernible] paying their bills as opposed to delivering

the excellent service. san francisco's been leading. please lead on this. do not allow kaiser, blue cross and all these [indiscernible] to bamboozle you into supporting something that is going to harm us [buzzer] >> madam secretary: i'm sorry, miss, your time is up on public comment. thank you very much. moderator, can you take the next caller, please. >> operator: you have two questions remaining. >> hi, rudy gonzalez, san francisco labor council representing 130 different unions here in the city. and among them, the 33,000 approximate city workers in our public employees committee. i think it's important as you talk about this agenda item overall plan review that we remember that kaiser is a prepaid system. they lack transparency with regard to their rates for these systems. they have posted in the first quarter of 2019 $3 billion in

net income, billion with a "b." we have seen massive creases to their revenue -- increases to their revenues, capital planning. this is untimely and i think we need to distinguish kaiser, especially in this conversation, from the other self-funded plans. when they increase rate utilization, they are trying to deter people from using prepaid services. it's absolutely immoral, particularly with public health crisis in this unprecedented challenge we face as a city. thank you. >> madam secretary: thank you very much, sir. moderator, can we take the next caller, please. >> operator: you have one question remaining. >> hi. i am so much opposed to this increase. there's a lot of people hurting, a lot of families hurting, such as mine, in this pandemic.

have some compassion. the workers, everyone on the line [indiscernible] the workers, it's time to protect the health care employees, and this is not the time to [indiscernible] please hear us. please do not vote on this motion. please have mercy and please with compassionate. show your humanity. all of your voices and all of your city employees, thank you. >> madam secretary: thank you very much, miss. moderator, can we take the next caller, please. >> operator: you have zero questions remaining. >> okay, we had planned -- >> president breslin: okay, we had planned to take a break after item no. 9, but here we are down the road here, and i would just -- i guess everybody is ready for maybe a 10-minute break? >> madam secretary: commissioners, would you like to

take a break? >> supervisor preston: i have some questions related to this agenda item. i'm happy to take them after a break or before, whatever is the pleasure. >> president breslin: item no. 10 you're talking about you have some questions about? >> supervisor preston: yeah, just some clarifications for mr. clarke, our director. >> president breslin: why don't you do that now, and then we'll take a break, before 12, item no. 12. >> supervisor preston: yeah, thanks so much. so just in light of listening to the public comments, as well as my own review of this, i just want to make sure i understand what's before us here. so the clerk or the president could clarify for me, when we are talking about the rate increases that you showed us in the final slide, are any of these costs that would be borne or paid for by members, by the employees, or are these costs to

the city? >> mr. clarke, you are muted. you'd have to unmute your mic. >> hopefully you can hear me now. >> madam secretary: yes, we can. >> supervisor preston: and if you'd like to clarify, i'm setting aside the issue of any increases to co-pays. i'm just interested on the rate and premium issues you raised. are any of those costs that employees would pay? >> yes, so for both active employees and early retirees there are specified cost-sharing distribution formulas on how total rates are allocated between employer contributions and member contributions. for the active employees, they are guided by agreements between those employee groups and the

employers. for the early retirees, those formulas are guided by city charter formula, and so as we go through each of the individual three presentations for kaiser, blue shield and united health care, i will speak to the application of those city charter formulas provisions for the early retirees and the active employee contribution determination provisions, specifically for the city county of san francisco employees in my discussion documents. but the other employers in san francisco health service system, in addition to city/county of san francisco each have their own individual active employee contribution/distribution formulas as well. >> supervisor preston: got it, thank you. and so we'll get into it i guess a little more with the individual items and look forward to that, but just -- more generally had a question,

again either for mr. clarke or director yant, typically in prior years is item no. 10 this overview usually presented to the board first and then at a subsequent meeting the various items in which we wrote to approve? and i fully understand that obviously in the last two months here we have all -- things have been turned upside down, so this is not meant at all as a criticism of these being all on the same agenda, but it just strikes me, and again as a newer commissioner, but it strikes me that it's very helpful to get this presentation on item 10 and hear the public comment in advance of actually voting up or down on the rate proposals that you'll be getting at later, and to the extent that that stragering is usually the way it would be done, i just -- for other commissioners' benefit, i want to be upfront that to the

extent that any of these future items we're going to be hearing on the agenda impose any increases, whether in co-pays or in rates that in any way could be passed on to employees i would be hoping to continue those items so that we can digest that and get further comment. has that been the practice in the past? is it usually staggered in that way? >> i'm happy to speak to that. thank you for the question. so historically we present the non-medicare rate renewal for health service board consideration in may and the medicare program renewals in june, and that timing is based on when the data becomes available from blue shield and united health care for aeon to complete its underwriting and prepare the rates.

so that typically finalizes the end of april. so may is the first opportunity to present for blue shield and united health care. and then for the kaiser rates, we receive those from kaiser permanente usually around the middle to towards the end of april, and so again may is the first opportunity. this overview presentation that i just completed, item no. 10, is actually something that was introduced last year for the first time. historically we've only just presented the actual rate renewal documents that i'm about to go through for items 11, 12 and 13. i credit executive director yant last year for suggesting that we also create this overview document at the outset of the presentation of each of the specific renewals. so for instance here in may we present this as a prelude to the specific renewal discussion

document for blue shield, kaiser and united health care. we'll do the same in june as a prelude to discussing the two medicare renewals for kaiser permanente, senior advantage and the united health care advantage ppl. i hope that helps to answer your question. >> it does. thank you. it's very helpful, and i know we're headed into a break. i never want to be the one standing between everyone and a break, but at the same time, i just -- just want to say, and you know, we'll get into individual items, but the comments from the callers very much resonate with me, and i think in my role on the board of supervisors i have taken a very strong stand around things like muni fare increases during this current situation. i think similarly the idea of passing on and increasing any of these costs right now on city

workers and essential workers is one that does not -- really does not sit well with me, but i suppose we will take that up in the individual items that come next, and i appreciate the overview. thank you. >> president breslin: okay. we'll have a break now, and no more -- i should say 10 minutes, be back here at 3:00. >> madam secretary: thank you, president breslin. ♪ ♪ ♪

>> this is commissioner hao, i'm here too. >> madam secretary: thank you all for confirming. we'll wait another minute, president breslin, just to make sure everyone's here. >> president breslin: right. >> supervisor preston: supervisor preston, i'm on. >> commissioner scott: commissioner scott, i'm on. >> madam secretary: thank you, commissioners. >> president breslin: okay. so item no. 12 then.