>> okay. agenda item number 1, call to order. >> to call the roll call. >> clerk: agenda item number number 2. president stephen follansbee. >> present. >> clerk: vice president chris canning? >> clerk: present. >> commissioner karen breslin. >> present. >> clerk: commissioner mary hao. >> present. >> clerk: supervisor dean preston. >> present. >> clerk: commissioner claire zvanski. >> present. >> clerk: and commissioner randy scott is absent. president follansbee, we have a quorum. >> okay. can we call the next item

agenda, number 3. >> clerk: agenda item number 3, approval with possible modifications of the minutes set forth in the august 13th, 2020. >> is there any discussion on this item? at the corrections or modifications from the board? >> i'll make a motion to approve the minutes, as presented. >> second. >> okay. i think we have an opportunity for public comment at this point. >> clerk: okay. the moderator will be opening up the phone lines. the slide presented gives information on the public comment call-in number, which is (408)418-9388, access code 1467291452.

for all attendees, please be aware there's a 30-second lag time from our presentation to sfgov tv, at which point we will give 30 seconds for people to catch up. and our moderator will let us know when attend eres and public comment is open. >> thank you, secretary. if you could please -- at this time we have two callers on the phone lines. zero callers have specifically entered the public comment queue. a reminder to all callers on the line, please dial star 3 now. if you would like to join public comment for this agenda item. we will wait five more seconds. commission secretary, there are still no public callers in the

queue at this time. >> clerk: thank you, moderator. seeings no public comment attendees, president follansbee, public comment is closed. , if >> thank you very much. we'll go ahead and call the question, all in favor of accepting the minutes of the august 13th, meeting, health service board as presented signify by saying aye. >> aye. >> carries unanimously. item number 4,. >> clerk: agenda item number 4. vote on whether to cancel the october 8th, 2020, health service board meeting. action item. >> so just as reminder, we cancel the october 8th meeting, toss it is open enrollment period and staff under is a fair amount of pressure to handle the open enrollment procedures. so any discussion on this item from the board members? >> i move that we cancel the

october 8th, 2020, meeting. >> i'll second. >> okay. so moved and seconded that we cancel the october 8th meeting. hearing no further discussion, we'll open it up for public comment. >> clerk: again just a reminder we'll wait for our moderator to open up the lines after the 30-second delay. >> madam secretary, if you could please share host privileges with me. we currently have two callers on the line. zero specifically had entered public comment queue. callers on the line, please dial star 3 now if you would like to join public comment for this agenda item. we will wait three more seconds and then close public comment.

commission secretary, there are still no callers in the public comment queue at this time. >> clerk: thank you, moderator. seeing no callers in the queue, president follansbee, public comment is closed. >> thank you very much. so all in favor of canceling the october 8th, 2020, health service board meeting, signify by saying aye. >> aye. >> any opposition? thank you. it passes unanimously. i'll call for item number 5:37. >> clerk: agenda item number 5, general public comment on matters within the board's jurisdiction. discussion item. >> so this item should be open now for public comments. please instruct the host to do that. >> clerk: all right. we'll have that 30-second pause. and the moderator will let us

know. >> thank you, secretary. currently have presenter privilege. if you could have host privileges, we currently have two callers on the line, zero have specifically entered public comment at this time. a reminder to callers, please dial star 3 now. if you would like to comment on this specific agenda item. we will wait three more seconds and then close public comment for this agenda item. commission secretary, there are still no callers in the public queue at this time. >> clerk: thank you, moderator. >> thank you very much. this item is closed. we'll now move to item number 6. >> clerk: one moment.

agenda item number 6, president's report. discussion item. >> thank you very much. so i submitted a president's report into the meeting materials. there are really two items. the first item is referral to the governance committee. and just to -- the board members are fully aware of the fact that apparently the city attorney's office has decided that each board needs time to have representation specific to the board that does not offer any potential for conflict of interest to attorney

consultation and to the system itself. in this case the health service system. we implemented this during our closed session member appeal in august. and it appears that -- i have asked randy scott and the governance committee to look at our terms of governance to make sure that we have clarified what situations, which should be quite rare. we would ask that we have specific representation to the board, distinct from representation to the health services system itself. no one should take to this to imply that we're unhappy with any of the services we receive from the city attorney's office. but i think as a matter of good practice, to make sure there's no confusion over the advice that the board is receiving in this situation. so i referenced that in the first item.

in the report. the second item is that chair randy scott couldn't be with us this afternoon to report on the governance committee meeting on september 3rd. and the report, which he has reviewed, is present for you looking at again the -- look at the r.f.p. process, including the scope, objectives, timeline requirements, restrictions for the calendar year 2020, non-medicare health care options for active and early retirees. again being clear -- not covering any of the current medicare plans. so the report is available for you and we will hear more about this in terms of when the r.f.p. will finally be released to public view, which includes a

view by all board members. we'll hear about more of this i think in the director's report. during the committee meeting, it was raising the possibility of board members being present -- at the earlier points of the process before the final presentation scheduled now for february 2021. particularly the possibility of some sitting in on the file interview process was raced and direct -- was raised and they'll report back to the health service board with recommendations to the fees county, as well as the definition for the observer role the health service board members in this point and the process. we'll present that hopefully at the november 12th health service board meeting for

discussion, potential action. so that concludes my formal president's report. i'll open it up for discussions, questions from the health service board members. anyone have any questions or comments or additions? hearing none, we'll open this up for public comment. >> clerk: okay. we'll have our 30-second lag final. >> thank you. you have two callers on the phone lines. none of those callers have specifically entered public comment queue at this time.

a reminder to all callers on the line, please dial star 3 now. if you want to join public comment for this specific agenda item. we will wait three more seconds and then close public comment for this agenda item. commission secretary, still no callers in the public comment queue at this time. >> clerk: thank you, moderator. no attendees in the queue. public comment is now closed. >> thank you very much. so now i call item number 7, director's report. >> clerk: angel item number 7, director's report. discussion item. >> good afternoon, commissioners. i would like to start my director's report by that our

chief mention officer, this is her last health service board meeting. quite a few meetings at this point. and i do want to read to you what is forthcoming in a proclamation from the board of supervisors. whereas on behalf of the city and county of san francisco, i'm pleased and honored to recognize pamela on the occasion of your retirement from the health service system, throughout your 20 years of service to the city and seven years as chief financial officer of the health services system. your work has driven financial and operational improvement, necessary to provide the best care to san francisco retirees and employees. your passion to provide exceptional service and devotion to your fellow san franciscans is very admirable. your years of service to our city are truly commendable and represent san francisco's values as the best.

therefore, i -- this read that the seals of the city of san francisco is affixed to this. we anticipate the signature of our mayor london breed. so thank you, pamela. it's been great working with you and i know you're ready to move on into your new life of retirement in a state with healthier air. and so best wishes to you. i'd like to give the board members an opportunity to comment. >> i'll take a moment to thank pamela. my short time on the board, ms. leaven has been extremely helpful. best wishes to you in the next chapter. >> mary hao.

i want to wish you a great chapter in retirement and thank you for all the hard work that you've done for this department, also for this board. and for the city and the county, too. >> hello. this is claire zvanski. i also want to thank you. i was actually able to read all of the finance reports that you gave and understand them. so i appreciate that very much. and the only warning i have is someone who has now been in retirement a few years is be really weary. people will ask you to do all kinds of things, because they think, oh, you're retired. you have nothing but time. and before you know it, you'll end up busier as a retiree than you were as an active employee. so be aware of that. and i hope that even remotely you will consider joining raccsf. because we'd love to have you in

the membership any time and so i'll figure out how to send you an application. but good luck to you. enjoy your retirement. and do what you want when you want. don't let others hook you into anything. take care. >> thank you. thank you. >> this is karen breslin here. i wanted to congratulate you for one thing and wish you the best in your future, wherever you may go. and thank you for all your work at h.s.s. >> thank you. >> this is chair follansbee. a hard time balancing his checkbooks. but thank you for, number one, your patience and your tolerance it's been quite a learning curve for me. i really do appreciate the time you've spent both with the board and in service to our members and the city and county of san francisco. also personally -- on a personal level, to help me understand and

progress. let me know when you stop dreaming about work and have nightmares about the work you've been having to do. congratulations and best wishes. >> thank you. >> and this is dr. dean. i just wanted to add my thanks for your service and best wishes in your retirement. as the newest member of the board, i had barely joined the board when i learned of your retirement and was struck by how unhappy everyone around me was about the fact that you were retiring. probably says a lot about your work. but i really do appreciate the work, especially so much of what you do is work that occurs behind the scenes, is work that enables us on this board to actually play the oversight role that we play and keep the system running. the stuff that i think generally often the public does not see

and certainly doesn't know who is doing a lot of that hard work. so i want to thank you for your longtime service and wish you all the best in retirement. >> thank you. >> i have a couple of comments. pamela, -- [indiscernible] over the last couple of year, i've been honored to work with the health service system. i have learned a lot about the health benefit business and insurance and about myself. and i have worked in the public sector for almost all my career, because i wanted to make a difference in people's lives. the experience in both this department and the department of public health have been tremendously satisfying. i want to take this opportunity

to thank my staff for their work, in addition to paying the billing, procuring resources and creating and monitoring two annual budgets. they create the booklet rates, they rate decks produced by anne. they produce two reports for the board each month that are put together to form one report. and they ensure that we're not getting overbilled by the plans and continuously update the policies and procedures. their job is behind the scenes and it's critical to the department. i would also like to thank and recognize the contributions -- contributions of the leadership team. they help me do my job, as much as i help them do their job. i'd also like to thank the department staff as a whole for their contribution to the success of the department. finally, i'd like to thank abbie

yant and mitchell griggs. we've done a lot of good work together. i'm confident that you will be in good hands with larry, the incoming c.f.o. he has a lot of great experience and he's very smart and talented. although he's only been here for a few months, he's already made significant contributions to the finance area. and i will be monitoring the changes that are made, of course, in the retirement, early retirement. i will be in mexico the end of october. and i really am looking forward to having another area, another, as people have said, chapter in my life. so thank you so much for the kind words. >> thank you, pamela.

just to continue for a moment in the area of personnel, pamela did have an opportunity to be involved in the hiring of one of the interns that we had in the department as the principal accountant in the financial area. todd carol has just started the last week i think on that team. and it's -- that's kind of a nice circle. the city has a very excellent training program for accountants. and we had an opportunity to work with this gentleman during his training. and as it turned out, he was in the select -- available for selection when we had an opening. so it was competitive, but he did well and he's joined our team. and we're really happy about that. we also in the area of personnel, we continue to struggle with recruitment, with

a member services manager. the position has been vacant for some time. we're engaging the help of a recruitment service to help news that regard. it is a critical position, as i'm sure you know. and the employee is doing double time, doing that work. otherwise we're pretty steady footing personnel-wise these days. i did want to give an update on the r.f.p. to my technical team, if we can call up that slide. i'd appreciate it. the notice of intent to issue the r.f.p. went out a few weeks ago. we've heard from a number of entities who have engaged and told us they may be interested in respon responding. mutual confidentiality agreements have been signed, as they entered arena, if you will.

we're currently on track for a release date of monday, september 14th. in that process, everyone has access to the full r.f.p., not the questionnaire. that is housed in a secured manner. but the r.f.p. itself is readily available for folks to look at. and then there's a pre-proposal conference on september 16th. we do anticipate questions to be coming in, as soon as we release that r.f.p., clarifying questions, all kinds of questions that come in. michael visconti is our contracts manager and is doing a heroic job helping us orchestrate this complex process. and we centralize all calls, all emails go directly to michael.

i don't take them. i forward them directly to michael. i don't answer them. he is the one who is authorized to respond to those questions. and we will do them together. because often we get a lot of the same or similar questions. so it's good to kind of compile all of those. and those questions do get published during the week of october 5th through the 9th. so we'll be more date-specific as we get closer to it. but that's where we are. there was a tremendous effort on the part of many folks on our staff. and i think michael really led us along. we had brian as a project manager. we had anne thompson and my clerk from aon. and everybody, kerry in well being, marina in the enterprise and data fields. that's all very important

information. mitchell, of course. if not stating anybody's name, i apologize. but it's really -- it's really been a tremendous opportunity to come together on a document of such importance. so we'll see it on the 14th. and the website -- i'm sorry i didn't put that up again on this slide. i hope you all have it. it's on our board -- it's on our h.s.s. website. and pretty easy to find, if you just go to the board -- the main board web page. there's a drop-down menu about us and there's a section for r.f.p.s. it's very easy to locate. i want to move on the director's report. you can take down that slide.

we did look at the technical improvements -- technology improvements. quite a bit of research and looking at what our current options are with technology. we did kind of go full circle, in that we are still instructed and guided and supported to use the webex tool. the at&t bridge line is no longer available to us, which is probably a good thing, because it failed multiple times for us. so the system that we're using here today is what is advised and supported by our technical team, of which we have several people on the call that are really helping support the team. so it is not perfect. but we are putting all of our efforts into making it the most functional as we can for these

meetings. the second thing that i was asked to report back on and did put -- with holly's assistance, we put together an email tracking men random to the board as to how we're managing the emails. we're developing the tools and we'll be able to report out how many emails we get and who is handling them and how quickly we're able to close them. we either handle them on an individual basis resolving problems as they come up, as we're accustomed to. and sometimes they are items that we report back to the full board just as we would follow up on other public comments that come in during a board meeting. so we don't get a lot of email. so it should be fairly straightforward for us to be able to report out a summary to the board and we will be doing

that -- putting the report together now. that will be available to you. the divisional report updates. mitchell will be doing a presentation. so i won't steal any of his thunder. the member services are staying busy. 4300 calls in august. it is a busy virtual call center. i really commend all of our staff for continuing to work so successfully in this telecommuting world and manage that kind of call volume. the enterprise systems are supporting a lot of the activities. we were over the last several months able to go live with e-benefit enrollment for new employees, as well as people experiencing qualifying life events during the year. that's really been a huge asset.

the communications team is integral to all of these processes and the web traffic numbers continue to go up. a focus on user interface and how easy or not it is for our users to find the information that they're looking for. some webinars and things that mitchell will be talking about. and then there's been quite a bit of cross-divisional support for well being, as their activities, too, have switched to the virtual environment. and the promotion of the 24/7 e.a.p. services and apps for public safety. so there's been quite a nice partnership in promoting those services. we did, just as an aside

quickly. yesterday when the bizarre weather was upon us, we notified our vendor and they did get a record number of calls yesterday. it's working. it's really great that we have these programs in place for our area. our racial equity program is under development, as you heard at the last meeting. we are doing our training plan and findings lots of opportunity for cross-departmental conversation and complementing each other on -- or figuring out how we complement each other, whether it's d.h.r. or the new office of race and equity or ourselves and how groups are being facilitated. how issues are being mediated. it's a growing list of

activities that many departments want to do in trying to figure out how we do that together in a complementary way is a lot of the informative work that's being done now. there is a very long list of legislation tracking that was attached to your -- to my director's report. it actually was a truncated version. and there are way more bills. i can't say there's necessarily a lot of activity. because both at the federal and state level there's a lot of ip activity on -- inactivity on legislation that was not acted upon. need i say more, it's very odd times we're working in. and included in the director's report as well, is the financial report. larry is available to answer any of the questions you might have on that. i do want to note that we're in the middle of an audit with a new vendor. it is moving along. it's a little slower because they're new.

but our team is not new. so we're being quite helpful with them realizing what they really need, versus what they say they do. so since we have a lot of experience under our belt, it's been kind of a good partnership to learn together. also there's an audit report in there, as may recall. we put together an audit plan for 2020. and we are moving forward. the first completed audit is a mental health parity audit. and there were no significant findings. so that's good. that concludes my report. i'm happy to entertain any questions from the board. >> so i'll open it up to the board members. any questions? i can't see everyone's screen.

so if you have -- you can also use the little raised hand icon. i'll follow that as well. so i'll open it up for questions. i'll call on the -- >> yes. okay. i got my hand raised. [laughter] >> yeah, i see it. >> i was trying to get the little hand up there. >> you did. great. >> so i wanted to ask you about the board emails. so i look, you know, at the automatic response. thank you for contacting us s.f. health service board. your message has been received. please direct all questions to h.h.s. member services. at the phone number. but i find it very cold message,

sort of. you know, kind of like we're putting you off -- yeah, we got it. but, you know, don't bother us or whatever. so do all messages get a response, is that right? >> yes. and, you know, it's funny. holly and i were work on an alternate response this morning. because it felt a little stiff to me as well. so we're going to modify that, so that it reads better. >> yeah. because we are not always getting -- i would like to see their emails, you know. i know you say certain things in there we can't. i'm wondering if a way to get around that. because in the past people have emailed. we have gotten a second one. they said we tried before. you never responded. so sometimes they just weren't responded to. so i was never really quite sure of the procedure, you know. i guess it goes to the secretary and then the secretary responds, is that correct? or it goes to --

>> i think we explained in the memo, commissioner breslin, that we make sure the person who can manage the issue gets the email. so it's generally mitchell or i. and so then we take upon ourselves to work with them and their individual issue. and similarly to what we often hear some of the public comments at the board meetings, their issue may be representative of something bigger than their issue, right. so i put that in a list of things to follow up and try to address them in the director's report, so it becomes sort of a policy issue. so ting when we get our -- what we haven't presented to you yet, as i said just working on some of this this morning is, you know, a report. there's not that many -- a, there's not that many emails that come in. there's not that many that we don't share them with you.

so it's not a large number. but i certainly appreciate you feeling like you're not seeing everything. and so we're trying to rectify that as best we can. >> okay. yep. thank you. there has been times in the past where we received a lot of them. >> yeah. we did in the may, when we had the kaiser discussions. quite a few. i think about 20. i mean, it wasn't like hundreds. but they were, you know, as they were in the verbal testimony, their message was all the same. and i don't know if -- i think we sent most of those to guys. i think we did. >> i might have forgot. >> yeah. so, yeah, generally speaking we're getting one, two a month. it's just not very many. but you'll -- we'll work to get that report out to you.

>> yeah. i just want to make sure they're not slipping through. >> yeah. i agree. i agree. thank you. >> so, commissioner breslin, one, put your hand down. >> okay. how do i get it down now? i just click it. >> click it again. >> okay. >> number two, doctor -- >> it's still there, though. >> click it again. >> in any case, the other issue i'm sure that if you get -- if any of you get requests from members, regarding these kinds of issues, automatically directing them to holly, -- >> okay. pardon me, there's really a lot of feedback. i don't know if there's something going on in the background or what. >> yeah. somebody is not muted or something. there's a lot of feedback.

>> president follansbee, you might want to adjust where your mic is falling. >> okay. it may be coming from another source. >> clerk: okay. >> i think it's better now. thank you for bringing that up as well. so we should be directing our questions back to holly, who can then track the complaint and follow up with that. in that memo was the fact that all of the health service board members are going to be migrating to an sfgov.org. and because the messages are being screened now by algorithms i understand through i.t., that may screen out some of the documents or whatever. and put it into a secure message, which can be bypassed

if we use the sfgov.org. i just activated mine. so the board members will be acted by holly about that as well to implement that, hopefully by november. so, clare, you have your hand up. commissioner zvanski. >> yes. when you mentioned that this algorithm is monitoring the emails. i'm wondering does this have anything to do with the fact that we've had difficulty with some of the materials in preparation for the board? is it part of the same system that's being monitored? >> dr. follansbee, i'll take this one. what it is, the email system, which is very vulnerable to cyberattacks, because we're a big government agency. a tremendous number of security that is have been stepped up over -- that have been stepped up. very much so recently where a

lot of email attachments going out from us have some keywords in them that create an automatic encryption of those documents, unsecured email accounts. by having your personal account, you're in an unsecured email account, which is why we need to switch to sfgov.org accounts for you, so you can receive the documents unencrypted. and we just have to make that move. because we cannot support your personal emails, nor do you want us to. and so we can support the sfgov.org and get used to using that and that should remedy the problem. i apologize. we did not anticipate this problem. in hindsight, maybe we could

have. we didn't anticipate sending the board documents to you that you couldn't figure out. i know we got it figured out. and holly and the team, thank you for doing that. but going forward, the solution is to have you convert to a dot gov email. >> we already have the email addresses established, right. you just want us to activate them? >> yes. and to use them for your board business. >> no problem. okay. thank you. >> yeah. and i mean if you think about it, too, it just gives you the added security. we're all as government entities subject to public records act. and sunshine act. and so you probably don't want to be using your personal email for government businesses. they would then be included in that kind of a search. so save yourself a headache and

just use this for that. just use the.org emails and and we'll support you in that. we have the ability to do that. >> great. any other comments or questions from board members? if not, then we'll go ahead and open this up for public comment. >> clerk: thank you, president follansbee. we'll have our 30-second pause to allow time for the callers to dial in using the information that is on the screen. and our moderator will let us know if there's any public comments in the queue. >> thank you, commissioner. there are currently four callers

on the line. no callers have specifically entered the public comment queue at this time. a reminder to all callers on the line, you must dial star 3 now if you want to join public comment for this specific agenda item. we will wait three more seconds and then close public comment for this agenda item. miss secretary, there are no callers in the queue at this time. >> clerk: thank you, moderator. seeing no comments in the queue, public comment is now closed. >> okay. so that concludes the director's report. we now will call item number 8. >> clerk: item number number 8, agenda item, presentation of the open enrollment and worksite flu clinic plans 2021. discussion item.

>> good afternoon, commissioners and president follansbee. this is mitchell griggs, the coo coo at health service system. and as typical in september, i like to present an overview of open enrollment and today we're going to include, after open enrollment, the work site flu clinics. both of which are going to look a lot different this year, which goes without saying. so, you know, i wanted to let you know this is one of our big shows and operations in member services. this year is going to be quite different. we want a public notice for people, of some of the changes that we're doing operationally for open enrollment. and we're expecting, you know -- i hate to say it, because as soon as i say it, then i'm sure something might happen. but we're expecting a light enrollment, because of the fact that earlier this year, i

believe it was in may, the board approved some i.r.s. notice changes, which allowed people to go ahead and make benefit changes throughout the mid-year, including some f.s.a. changes and dependent changes and all that type of thing. so we're thinking a lot of people have already put their changes in that they would like. so we're looking for a bit of a light enrollment this year. let me go ahead and start showing the slides. slide 1. i'd like to show you, you know, the basic mechanics of how our open enrollment mailing is going to go this year. as i do every year, the design of the mailing, which goes to all active employees and the employers and the retirees, of retirement systems, whether they're enrolled or whether

they're waived, everyone will get a mailing of some sort. and this is basically what it looks like. every year we have our open enrollment letter there and the envelope. we try to encourage people to open immediately. as you can see, our typical scene which is the "o," the pictures with the "o" for, you know, open enrollment. and this year we managed to incorporate some timely photos, sign of the times i guess. and had some employees in masks. everyone does get a paper open enrollment notification. we have not switched to electronic notifications yet. we're hoping to do that until next year. keep our fingers crossed. okay. next slide. within this envelope and along with the personalized letter, everyone will get an open enrollment booklet, which contains all the information that people need to make their

open enrollment choices. and it includes compliance information and other regulatory information that people need to get every year. the color-coded based on the employer or retiree. we have also included on the front for the first time this year a very expensive step-by-step guide to help people through the thought process of making their decisions during open enrollment. and everyone will be getting a booklet this year. in the past, we for whatever reason, we had some of the groups where we would do a full benefit guide. like i think last year retirees, everyone got the benefit guide and not the smaller -- smaller footprint of paper booklet. and if we can go to the next slide. the benefit guides this year seem kind of a graphic representation. they'll be available

electronically on our website. we will not be mailing them. we'll be printing them, hard copy. they'll be available by the first of the year. a few reasons for this is, you know, number one, it decreases the amount of paper demand that we have. so it's thoughtful that way. we also have a very good print and mail house. however, they're also responsible for sending all of the election materials for a lot of cities up and down the west coast. if you live in san francisco, you may have already gotten yours. it was printed and sent from the same place that we're having our mailings printed and sent from this. they're in the early stages of planning for open enrollment. the request was what could we do to make it more efficient. the big push for time to get the enrollment materials out. we all know the things that were going on with the postal servi

service, et cetera. you know, what can we do. and so we thought about it and really truly these guides were for new hires, new retirees. so they're more effective for the -- once the plan year has started. since we've done a lot of work and condensing these into making a more efficient booklet to highlight things for open enrollment. we decided to go that route. they will be able for people to pick up or mail them to them after the first of the year. right. next slide. this is just a breakdown of our mailing. you know, i would like to highlight here how many packets we're mailing. 77 -- about 77,000 this year, slightly increased from last year. we're breaking it down by employer here in group, city, county, court commissioners and n.e.a. about 33,000, 34,000.

all of them as well as unified school district this year are going to have access to e-benefits. so as you know last year, we moved all of the city, court n.e.a. so e-benefits. about 93% of changes that came in last year went through self-service. so we're hoping for the same and thinking the same this year. and the retirees medicare, non-medicare numbers are there. you see there's 226 aid benefits and 412 e-benefits for retirees. that's actually the people who have activated their accounts. there's many more. probably 3,000, 3500 more at least that actually have access to self-service. but either they haven't activated their account, for whatever reason, or they didn't make any changes. they will be able to activate

the account this year through us, calling the health services system and we'll get them set up and be able to get them going. next slide. as abbie mentioned earlier, we've been providing virtual member services since marc march 16th. and when we closed down the office, it's been very successful. i say this all the time. completely shocked our successful it is that we have been able to completely transfer to telecommuting, keeping up with the phone calls, and getting the work done. so i don't have any worries for us continuing that through open enrollment. the call volume is certainly going to go up. the one thing that's going to be missing is we had a lot of face-to-face interactions with members, particularly during open enrollment, where we will not be able to have that this year. the offices will remain closed

to the public. we have set up about seven individual offices at our, you know, office site at 1145. these are individual offices, where an individual, one person can sit in and close the door, if we need staff to come on site for whatever reason, if someone is having problems, you know, being able to work at home during the open enrollment, whether it's rolling power outages or internet connection problems. they can come into the office and have a safe, contained place to work and everything is set up there. we have it if needed. but seven at the moment. the majority of employees -- and half of the retirees have access to self-service. but as i stated before, the offices are closed. so people can still mail or fax or drop off their paperwork applications if they prefer to have paper during the month of

october. and i think that's the last slide i have, if i'm not mistaken. so kerry will be taking over -- oh, thank you. i did have one more. very important one. and that's our virtual health fairs. our virtual open enrollment this year is, you know, since we're not having any face-to-face contact with members, we've always had about 25 to 30 off-site events where we would go into the departments or city hall or, you know, raccsf meeting rooms to do these health fairs and open enrollment events. we're turning all of that virtual this year. so we're doing webinars, one for retirees on the 7th, for active employees on the 1st. and the 26th -- all of the

health plans will be there to get presentations. we will be speaking as well. there may be a question-and-answer section. people will be able to type in their questions through a chat function, which i think will go very well. these will be recorded. and they'll be on our website, so people who cannot attend, you know, will be able to access them on the website. we're splitting them up a little bit, because you know active employees, for instance, really during the work day have about an hour or so maybe for lunch. and so we're keeping it medical plans, one event and we're doing spend accounts and dental plans and voluntary benefits on a different event. again all of these will be recorded -- recorded and placed on the website.

i'm going to ask at this particular point if the commissioners have any questions, because kerry has got some really good, interesting information that you're going to want to absorb. so i'll ask for any questions about specific to open enrollment. >> so i'll open it up. for commissioners. karen. commissioner breslin. commissioner breslin, you appear to have your hand up. if you have a comment or question. >> forgot i was muted. thank you, mitchell. nice t to see your face again. it's been a long time. so i was just wondering when you were referring to the benefit guides, that were not going out, is that this booklet from last year? i don't know if you can see that or not. >> yeah. well, i recognize the individual

-- the rest of the booklet is blurred out by the background. i know what you're talking about. yes. so the full benefit guide that went out last year, will not go out during open enrollment this year. it will be a more refined version that's just specific to open enrollment. a lot of information there that's not speaking to what is, you know, changes, for instance. >> my concern was like if you want some changes then i would always be looking at this guide, right. so there's something else that will be substituted for? >> right. it won't look exactly like that. it's not going to have the nice thick covers. there's some information in there that's not specific to open enrollment, you know, that's in the benefit guide every year. what you're holding the 2021 version will be available by the end of the year, if someone would like a hard copy.

it's available electronically on october 1st. the hard copy, if people want hard copies, they'll be available near the end of december. >> good. thank you. >> anyone else have questions or comments? i think maybe -- oh, mary -- commissioner hao. i'll call on commissioner zvanski after that. commissioner hao. >> thanks. mitchell, i don't really have a question. more of a comment. i really like the thoughtful creativity -- thoughtfulness and creativity behind holding the digestible sessions by topic and by area for the members. so i want to just commend you and your staff on thinking that through in a very thoughtful way. >> yes. thank you. the communications department has worked really hard in helping me figure all that stuff

out. it's looking really, really good. we had a little practice session this morning. so looking forward to it. and they'll be available for the commissioners to check in and look at. >> thank you. >> commissioner zvanski. >> thank you very much. and, mitchell, on that same page, i'm looking at october 7th for retirees. i'm wondering how is the word -- and i apologize if i missed it, i was distracted for a minute. if i missed part of your presentation. how is the word going out to these populations and especially -- my biggest concern is retirees, because when you're working for the city, you've got city email and you know how to get ahold of people. but once we retire, we sort of disappear into the ozone. and all of the retiree organizations, that i have been working with since i retired, we all have the same problem in

contacting retirees. so i'm just wondering how that word is going to get out? >> right. so they're included in the open enrollment mailing, the date, the mailing that's going out. it will be in there. and we are -- you know, there's also the e-news, you know, hopefully people subscribe to that. we try and encourage that a lot. even to the active employees to subscribe to the e-news. it's becoming very robust these days. it will be on our website, too. big banners hopefully. and, you know, this is also public notification of it. and we certainly reach out to the associations, retiree associations. we work with them to make sure that that date gets out well.

>> so thank you. mitchell, i just have one comment, that is i have watched over my five years now on the board the migration to e-benefits. and i wholly applaud this. i think that it makes, you know, a lot of sense. i'm really glad to see the increased numbers each year. and anything that we can do as board members to increase that and encourage that and decrease the sort of need for face-to-face encounters. but also just the paper enrollment forms. you know, we're -- my understanding is they're relatively onerous and always opportunities for errors to go in. so given the tenor of the conversation around other issues around mail-in versus security and all that, could you just comment on the security of the e-benefits system, how members can be assured or are there

other concerns. >> right. well, you know, again it's the city's system. and so it is -- you're coming through when you go to self-service, you're coming through what we call the employee portal. even when you're a retiree. and the security behind that is, you know, is just as it is when we're in there doing our work and our payroll and managing these individuals' information. so it's the same system. so it has the same security. and, you know, certainly that is a lot more secure than, you know, putting your paper application and your documents as far as birth certificates are concerned, you know, in an envelope and sending that -- or dropping it off. that type of thing. it is a much more secure system.

and i think as far as adherence is concerned, now that we have it up and running for the majority of the employers, i think our biggest -- i'm sure clare will agree with me on this. one of our biggest moves now, moving forward, would be encouraging retirees to use it. and there's a lot of them that are computer-salvey , some more than me. there are some that aren't. i can understand that. but those who do feel comfortable using a computer, we want to see what we can do to get them to use it more often. and to show them that there's a lot of information that they could be looking at, not just doing their enrollments. there's benefit summaries in there that they can view, show them exactly what their benefits look like at that particular time. and i think we're going to move now that we have, as abbie

mentioned, our mid-year changes, new hires and new retirees now can do self-service. it was just open enrollment last year. but now that we've got that big hurdle, we've crossed that. i think we can look moore to adherence -- more to adherence and finding ways to help people and thank you for the board wanting to help with that, too. certain things we can do and we have some ideas. but i definitely think underscoring the security, highlighting it. i'm sure rin can, you know, add a lot to that and how we present it out there and to convince people and assure them that it's secure. >> great. thank you. i'll call on vice president canning now, who has his hand raised. >> thank you. just a brief follow-up question. mr. griggs, related to the conversation. specifically of the retirees in particular, who may not be azt -

as tech savvy moving online. i presume that the staff there, if phone call is received, would be able to walk a retiree through basic components, operating in an online environment. and i have no doubt that that's happening. but i think just for the public's benefit and for other members of the board, that may have questions about that operation. i presume that is a plan that is in the works? >> it's been part of our moving into self-service. i call the tech squad there at all of our events, all site events, including going to rcassf. and including all of the retirees, would walk them through and show them what it looks like to be online.

so during what we have come up this year, since we're all virtual, is that we have some staff that were focusing -- are going to focus on those types of things, desktop support, tech support. someone says i really want to do my enrollment online, i'm not sure of this, that or the other. they would be able to speak to a certain subset of our staff that, you know, that are good, you know, at that type of thing. as well as we have some of our i.t. people scheduled to show able to come in and take the call, too. and, you know, if we need advanced technical support for members. that's what we're currently doing. and again it's moving benefits analysts from, you know, liking the customer service and helping members with their benefit issues. kind of moving them to a technical support, too, it's a

little bit of a challenge. it's something that we have worked on as we did the soft rollout, soon to be two years ago. we often have a very, you know, not only in our website, but also in our benefits materials a step-by-step guide for people to follow. and we did a lot of work on it this year. we're looking for a lot of feedback. and that step-by-step guide and telling people how to make their decisions and then go online. so there's been a lot of work in the written instructions and stuff from the website, too. so that's what we're currently doing. but again taking everything that we learn every year and we get the feedback we get. and then trying to improve further every year. >> thank you so much. >> great. so now we have a comment from -- a question from clare, from commissioner zvanski. >> yes. thank you again. sorry.

mitchell, we have at least -- i think it's close to 5,000 people that i know who are among older retirees who do not have computers, will not do anything online, no email, none of that. and there may be more than that. but those are some numbers that i have noticed in some various -- when i put all of the different retirees organizations together. it's at least that many. so i want to thank you for doing the mailing to everyone. because i think that's going to be critical. and maybe you'll probably find out who doesn't have the electronic capability. and that's going to be with us i think for a while. so i appreciate all of the work that you have done and also having additional staff available when those phone calls come in. because this is probably the older, older group -- say older, i mean, these numbers take on

different significance with each year. you i suspect that many of these people are well into their 80s, late 70s and 80s and will need the help. thank you very much in advance and appreciate the fact that you have acknowledged all of that and will be doing an extensive mailing. thank you. >> thank you. >> so thank you very much. i think we'll open this up to public comment until we've heard both preparations. -- presentations. with that i'd like to move on to the second part of the presentation, which i believe is kerry beshear. is she doing this? >> yes. kerry. >> hi. good afternoon, everybody. kerry beshears, well being manager sfhss. so as you can manage, flu clinics will look a little different this year. i'm going to start with providing ath bit of a background information. so each year we partner with

kaiser permanente for on-site influence clinic, location -- flu clinic locations throughout the city. we typically offer between 26 and 27 locations. and tend to see around 4,700 vaccinations distributed. we do often break down our clinics into what we call open and closed or open and restricted. so open typically is a clinic that any one of our members, our employees, our retirees and even our spouses and domestic partners of our retirees can go to that location and get a vaccination. we do often also have locations that are restricted or closed. that typically is due to limitations around gaining access to that building, specifically. so often times we will see either our first responders and employees who have access to that location through badge, would be able to get their vaccinations at that particular department. and as i mentioned earlier, our

clinics do serve our employees, retirees, including staff and domestic partners of our retirees for all of our four employers. next slide. so as of last friday, we actually have 20 clinics confirmed. there have been some updates to the information i'm presenting today. so i'll note those updates, as of yesterday. so currently there are actually three clinics that are open. the slide notes four. however, there are three. the three that are open are the clinic on ten eight, scheduled at the county fair building. that will be in an outdoor space. the 10/20 date and the 10/22 date at south van ness. these are what we currently have as of now. we're continuing to look into offering additional clinics,

specifically those that can target everybody. next slide. so again naturally there's a lot of things different. this year we're putting a lot of attention toward our communication plan. mitchell was alluding earlier to our retirees getting a mailer within that mailer, there will be an insert. so it contains specifically specific on getting flu vaccinations, particular through their health provider, because of the time we needed to put our information to the print house. we didn't have all of our clinics confirmed at that time. we'll be doing a number of citywide emails and targeted emails for our health plans, specifically breaking it up into each one of our health plans and for our retiree populations. we're going to be testing out a citywide bridge system. it's actually allows for us to have the opportunity to text all of our employees and have them acknowledge that text about

getting a flu shot or where flu shot clinics might be throughout the city. one of the things that the well being division supports is a key player network. it's approximately about 220 to 250 citywide employees. leaders and managers that really help to support well being and so we will be utilizing our key player network and pushing out some additional notifications. and then bringing on the app, a few months back, we will be working to do some push notifications to our first responder groups as well. once we prepare for all of our events, we actually enter into a planning meeting. the planning meetings are driven by kaiser. our team is present and we have someone from the department or that location is also on that call. it allows to us go through opportunities to talk about the logistics, what's going to happen on the day of, answer any questions.

this year what we have also done is we have created what we call a departmental tool kit. that tool kit outlines health and safety measures, rules and responsibilities, so that includes the role of sfhss the role of kaiser, the role of the kept and also really breaks down what the employee experience will be. and i'll take you through that in a little bit. and then a floor plan. so naturally we want to assure that we're implementing all the health and safety guidelines that are in place to particularly help with physical distancing, signage. so those will be things alleviate sit -- separate exits and entrances. we've been partnering with d.p.h. to ensure the health measures are following those -- that have been outlined -- from the health officer.

in addition to that, we are requiring appointments this year. that is new than what we've done. internationally that's going to help us with flow, crowd control as we call it. and ensure that between our team and our provider team that everybody's -- making the health and safety environment. also allowing for a smaller through-put. so the nurses will be able to see about 12 individuals per hour. so one nurse, 12 individuals per hour. and that will also allow for additional time for cleaning in between each vaccination, in addition to our staff helping with planning and sanitizing of chairs in specific areas where we might have those for people who are either being observed or who are waiting. we are also working to ask people to fill out the informed consent, the vaccination and informed concept form, prior to the event. so that will be in part of our messaging. they can print it out, have it

prepared with them when they come. we will be asking individuals, who need a copy of that form, to take an image with their smartphone. the good news is we'll have backups. so if someone attends the clinic and either they forgot their paperwork or they would like a carbon copy, kaiser will be providing forms and single-use pens. so people will walk away with their pens, in the case that they would like to get a copy in that form. next slide. so i'm just going to wrap up a little bit about what the member experience will be. so these are some -- there is some additional changes on this slide, as of yesterday. i'll note those. so we are -- the sfhss staff will be present in all of the clinics and we will actually be facilitating a health screening. so the health screening -- and on this slide there's actually a

link to the online tool we'll be providing. a paper tool. so people will know in advance what those questions will be, when they're entering into a facility. we're just going to remind them that they need to bring their printout of their consent form. they will need to make sure that they're prepared with an appointment online. so we will be checking to make sure that they do have a scheduled appointment. and then we're asking employees to make sure they're prepared to bring all of those items and/or if it's a retiree, that not only that they're bringing their medical i.d. form and our employees are bringing either their d.s.w. badge or department-issued badge. we are requiring safe masks as well. anyone to enters the facility without a face mask, will be asked to get one, if they do not have one, we will have the ability to provide them. but we will have limited supply. then, of course, those who aren't wearing their face masks

properly, our staff will the ability to help guide them on how to do that. and again these are all things that we'll be communicating up front with those who are scheduling an appointment. so they can be prepared on what to expect. so once they get to the clinic, as i mentioned, they'll be meeting our staff, we'll check that they have a appointment. we'll perform the health screening, ensure the mask is worn properly, check the badge or medical i.d. card and they'll move into another location within the facility, where they'll be met by a kaiser administrator. that administrator will review their paperwork or give them the paperwork where they can complete it. and then once that's complete, they'll move them into the first available nurse station. once they've been vaccinated, if they have been vaccinated in the past, they will be free to exit the facility. however, if it is a first time in which they are actually being vaccinated, they will move to an observation area, so they can be observed for that 15, 20-minute

length of time that they need to, prior to exiting the facility. so at this point that concludes the presentation. >> so thank you very much. so are there any questions or comments from health service board members? i'm not seeing any raised hands. no questions or comments. so i will just comment from my background as an infectious disease doctor, that we're starting to -- i know that we all have friends who have been getting the flu vaccine already, through some of the other sites, including pharmacies. and, you know, i understand also there's been a fair amount of discussion in media regarding the importance of getting the flu vaccine. i just want to reassure the

board members and reassure our staff and reassure the public, as well as our health service system members, that right now there's been essentially no flu activity in the united states. we usually expect it to fall later in the fall and usually it follows activity in the southern hemisphere. so i've been checking through the australian public health system and the world health organization, which remains a vital partner in these kinds of issues, regarding flu activity. they warn us all that because of the covid pandemic, they're concerned about health systems being overrun and not being able to really provide the statistics, as one might in other non-pandemic years. to date the flu activity in the southern hemisphere has been

relatively. not enough ice lets to confirm what is circulating. and i think that i will reinforce the idea that it's critically important that we all get influenza vaccine. but you don't need to worry that the october 1st start dates are delayed or put us at risk at this point. and to follow the recommendations and certainly the health services system will keep members up to date, as well as the public health system in san francisco through its website, as well as your providers. we'll keep you up to date on recommendations regarding the flu vaccine. but everyone should plan on getting it one way or the other, my firm recommendation. again it's a comprehensive presentation. so if there's no other questions from the board members, i can't see any raised hands electronically. and i don't see anyone waving frantically at me on their

screen. i think we'll go ahead and open this up -- both presentations up for public comment. >> thank you for granting me host privileges. we have four callers on the line. zero of which have elected to enter public comment. if you are on the line and wish to enter public comment, please dial star 3 now. we will wait a few more seconds and then close public comment for this agenda item. commission secretary, there's still no callers in the public comment at this time. >> clerk: thank you, moderator. hearing no callers on public

comment, it's now closed. >> thank you. we can close item number 8. it's been an hour and a half since we have been sitting. so i think i would like to declare a short ten-minute personal break for members. and we will reconvene in ten minutes, which by my watch would be 2:37. okay. >> abbie and mitchell, can you stay on just for a second. this is claire zvanski. i got something in the mail today that i want to run by you, that's being mailed out indiscriminately. i think it can impact our open enrollment materials. >> i think we should maybe -- yeah. we will open that up as a first -- as the first follow-up item before we move to the next item.

if you think that it falls under the, number 8. so we will open that up for everyone to hear. >> okay. okay. that's great. i'll see if we can -- i haven't taken a picture of it, but hopefully it will be available on the screen. but i have some very serious concerns about this. thank you, dr. follansbee. i appreciate it. >> if you would take a picture, clare, and email it to holly, then we can look at it together at the board. if it's a public document. i assume that it is? >> i'll try. my phone keeps telling me i don't have enough memory. but i keep thinking it's a personal comment. but i'll do my best. [laughter] >> okay. thank you.

>> ok. roll call. [roll call] >> clerk: we have quorum. >> so, after we sort of called a break, commissioner had a question, actually, for official griggs partin regarding item 8. we'll open it up and we'll move on after that number nine.

i just picked this up in the mail today. it's a card that says 2021 medicare health plan update. return, reply enclosed. the information sounds to me like a solicitation and it says 2021 medicare health plan update. you may not be getting all the medicare ben its for which you are eligibility, and blah, blah, blah, it talks about dental, vision, gym membership, personal emergency response and transportation and then there's a business reply that is attached with no postage necessary and it sends says request to an appeal box owasso oklahoma. this has nothing to do with us. when you look at this mail, you don't know where it comes from and it sounds to me like a

solicitation. i'm concerned if this is going to all of our medicare this has me concerned because it isn't the usual we get for our members and they learned to throw that away and i wanted to alert you to this and i just don't know who else to -- i don't know if careen received this or anybody else in medicare on the board. >> this is is eric rappaport can you hear me. what's the agenda item that we're talking about? >> number 8.

>> it was eight. this came up because it dealt with that and raised questions about member confusion, i allowed it. >> this is the open enrollment agenda item. i make sure it relates to a notice item on the agenda. >> it does. >> ok. >> it looks like it's interfering with our open enrollment materials. >> if i may, we'll talk with claire off line and see what this information is and take whatever action that we can take. consumer protection matter outside of our jurisdiction but we can take a look at it. >> i appreciate that. i have to say, i did get get it either. this is exactly the same worrying that we get on our tv screens. and so my guess is solicitation

and it was not directed at hss members but police follow-up with that. so with that, i'd like to move on to item number 9. which xanax item. >> approval of section 125 cafeteria plan updates action item. >> mitchell greg chief operating officer. again, in september, i bring to you the particular items and they are action items. this one is the cafeteria plan document. this document, as well as the one that will present next are every time the agency and service makes changes, we bring it to the board so you are aware

and that's why it becomes an action item. this is demonstrating not only to you but the public that we're planning to make and the administrative and in particular to the cafeteria plan most of them are irs changes and some are operational and again this is the service notice. public notice. as well as to get your approval so with that being said, we can see the summary here. if you recall, i mentioned earlier, i believe it was a main meeting we proposed an addendum to the 2020 planned document and based on irs changes that allowed employer groups to make due to the covid-19 responses, making some changes. so that was an addendum to 2020.

now we're in 2021 and some are going to a ploy to 2021 and i'm going to highlight that. the first change is we will update our healthcare expenses from the current $2,700 for 2020 maximum to a maximum of $2,750 for the 2021 planned year. along with that, the irs has approved us employer groups offering flexible spending accounts for healthcare and the next item to allow a $550 carry over so that means in 2020, if you don't spend up to 550 you can take it and apply it and use it for expenses in the following calender year. the next section, this happens every year, we're updating the flex amounts for city and county

employees, these are mostly and they get these pretax dollars and this is what section 125 of the internal revenue code is all about and they get pretext dollars to pay for benefits. and every year, this is mou based and so there are going to be changes in these flex credits. and the next one in appendix e here, one of the mou changes from last year, went into effect this coming calender year and that increasing the mea life insurance to 100,000. in that intext in the back, we list we bes list benefits that e pretaxed and the car nerria compliance and we indicate that and i think in the appendix

we're offering two new, throw te benefit to the municipal executive members and to all city and county and that would be met life critical illness that will replace avoiy critical illness programme and we have a met life accident insurance that will replace the previouslily offered voya plan. for those two benefits. if someone wants to keep their voya benefit they have, they can do that and they have to up-end to keep it otherwise, we'll be replacing an offering with this new metlife benefits. as well as a new identity net protection by all state. so those are the changes for the cafeteria planned document for the planned 20-21. if there are questions, i can answer them now.

>> any questions from the board members? >> i don't see any raised hands or any flailing hands. any questions from the members of the board. ok, so i think we'll go ahead and open this up for public comment. >> thank you, president. i'll give a brief summary since we've been here for a little bit that public comment is available on channel 78 and the opportunities to speak during the public comment period are available fee a phone dealing the access roads and we will take a 30 second pause to allow time for callers to dial in using the information on the screen. >> if i can interrupt, i believe this is an action item.

>> >> you actually are correct. we do need a motion and a second for me to open it up to public content. i apologize. >> i'll make a motion that we approve the revised member rules as it pertains to the cafeteria plan as presented. >> i second that motion. >> ok, so moved and seconded so now we'll move to public comment. thank you, very much for following protocol. >> we'll just wait for our moderator. >> yeah. >> >> thank you, madam secretary. if you can please grant me host privileges. we have two callers on the phone line. zero callers have entered the public comment queue at this

time. i remind all callers dial star 3 now. if you want to join public comment for this specified agenda item, we'll wait three more seconds and then close public comment for the agenda item. commissioner secretary, there are still no callers in the public cue at this time. >> thank you moderator and hearing no callers, public comment is now closed. >> i open this up for all in favour of accepting the cafeteria plan updates and as presented signify by saying aye. aye. >> and any opposition? >> it car's unanimously so we'll move on now to item number 10 which is another action item. >> agenda item number 10. approval of revisioned to health services systems membership rules action item.

>> >> every time we make changes, i want your approval as well as

public notice and this year, not too many and there's a lot of administrative changes every year like dates and that type of thing and one operational policy clarification really is the first one we've updated the language to clarify disabled dependent and saying they must be enrolled in hss medical plan and this is not technically a change, this is just changing the wordings. previously, we just said they must continually be enrolled with hss. i wanted to clarify that they had to be continuous loewen rolled in a medical plan. we've had past questions or requests and then some have been able to sneak through that they've dropped the medical plan after being approved or disabled dependent and just maintained enrollment. so, again, this is industry practise for disabled adult dependants and these are dependants that at age 26

they're disabled delivers back to the this is stating. the last change, we want to make everyone aware of we update the coverage period so basically that is populating these periods and appendix a for the payroll and coincides with the payroll and our eligible coverage periods are payroll periods so monthly periods for retirees and we put all the dates there we expect and the other employers

like the school districts have varying pay periods which they have varying covered periods and that's an annual update. that's all the changes for this year and if you have any questions, i can respond to. >> so opens up to board members for questions. any questions on board members? >> i don't see any raised hands electronically or flailing hands on the screen. so with that, i'll entertain a motion regarding this action item. >> i move that we accept the summary of proposed policy changes for membership rules as described by mr. griggs.

>> second. >> >> so moved and second and we'll up this item for public comment. >> excuse me, can i ask mitchell, have we had a number of disabled adults as we have a number of problems with any members and hearing disabled adults. i guess, i'm looking for, you know, numbers, i know that we have a fair number in our population but is this an issue or this is just coming to clarify. >> well, you know, from time to time we do get member maybe we

can make sure that stated medical plan. a few yearsing, we moved the certification of the disabled dependent process out of our office because none of us are clinical and if you are enrolling kaiser, your dependent will be through that health plan to confirm they're disabled, same with blue shield and city plan. we have had -- i can't remember the ex act amount, i think it's less than 10 recently. i think it's about 10. and the disabled dependent was not medical and they were enrolled in dental. and so we had to go in and

contact those members. >> thank you, very much, appreciate that. >> is this turned over for public comment and the moderator will let us know. >> thank you board secretary. we now have two callers on the phone line. zero callers have specifically entered the public comment queue at this time. a rewinder to all callers on the line, you must dial star 3 now if you want to join public comment for this specified agenda item. we will wait a few more seconds and then close public comments

for this item. there are still no callers in the public comment queue at this time. >> thank you, moderator and thank you hearing no callers and public comment is so closed. >> we have a motion to approve the revisions to health service systems membership rules for 2021. all in favor please say aye. >> aye. any opposition, it passes unanimously so we'll move on to discussion item number 11. >> i again da item number 11. presentation on sfhsf q2 cost utilization and quality dashboardashboard is a discussi. >> thank you. if you could go ahead and let me

have presenter control i will share my materials. >> yeah. >> hi, i am marina coalridge with the health service system and my preferred name is rim. i'm here to present our q2 express dashboard sourced from our all payer claims data base so this dashboard is generated from claims with incurred dates paid through june 2020 and just some other notes here that i'm

not going to read all of these buzz because i realize we may be short of time. they may not add up to 100% because we have people transitioning from non medicare to medicare and financials in our data base are not available for the medicare population so you don't see those metrics when we get into the medicare of our populations and any premium cost you see, they do include the basic vision and healthcare sun stains ability in there and and additional notes are high cost claimants and they are acute flare ups, which are manageable conditions that if you are having an acute episode, there's

the condition is not well managed and maintenance is just where we wanted the maintenance and then the other types of chronic conditions may not have a flare up or maintenance and those are just non stratisfied types of conditions. covid is top of mind on everybody's thinking and so, we do have some information related to covid-19 and this is just the technical details and we'll talk about those when we move forward. here are the key observations. this is incurred through marc march 2020 so it's not quantified at this point and we'll hear more from subsequent

to this presentation and the shelter in place order for those who may not recollect for six of the bay countries was march 16th so this data has gone through march 31st, 2020 so we're still often on the cusp of releasing impacts from covid. high cost claimants trend upwards and we see 107 more claimants over the previous period and the colt soft for non medicare retiree of increased over periods and the kaiser and united health care ppo and slight decreases with regards to our per employee or non medicare retiree cost per year. for prescription drugs and facility out patients costs, we see those two to three times

lower in the population than other other plans and our risk quarters along with the facility out patient cost significantly higher compared to populations and other plans it's north new many of we know that about that population as definitely a separate population and higher utilizing population. the active and early retiree population and we've got 2% of that population which is accounting for 40% of those costs. again, specialty drugs are dominating our top 15 as they have year offer year now. we're seeing three new entries into this area of new drugs that we hadn't seen in our top 15 and they're arthritis and it's for emerging diseases. within our medicare retirees we do see some decreases in per

1,000 visits to the e.s. and it's indicative and and the thousand days apply and an the other two wrist bands are healthy and stable and this is 4% higher than the previous period where it was a 79% of our medicare population the pop medications is low back hypertension and diabetes consistent with what we have previously.

so you can download and cruise it at your own leisure later on. for this monday medicare non men for our employees and early retirees there's about 47,302 members there and our total population is 94,113 which our average age 37.6 and the high cost climb ants is another 2% points there and your total and the larger ganes, that drove that increase were in the blue shield and our kaiser plan.

it's taken into account of a non medicare retirees and this is the 8% increase we saw in the kaiser population where we see the biggest change from previous periods and on the facility inpatients and in terms of larger dollar amounts and a lot of what the driver there was on the inpatient side was actually room and board charges and on the out patient we see some e.r. visits and also major procedures that seems like knee surgeries, we see major female gentile procedures such as hiss direct tommhiss to t -- here is alook e

from all of our plans and here of your copy of the risk course you are seeing may look different. there was an error i caught and it's been updated so we want to make sure the latest versions are out there on our website to that we will have access to the correct scores for this particular population. we have decease delaying care and so if we're not seeing the utilization on the claim activities then subsequently that what is driving these numbers and we'll see that play out a little bit more over the next couple of quarters and then

here is our quality indicators so just so you know, the complications that is encountering that have a principle or secondary diagnosis of complications from a previous healthcare interventions so that's where those come from and your avoidable admission are using the agency for healthcare research definitions and so, it's capturing an admission that would not have resulted as an admission if there was an appropriate treatment and it does look at some tech continues such as bacteria ma knownia and chf and copd and diabetes and hypertension and so all those things go into the readmission operate and that's actually

using a 15-day and i know that the season is 30 day we're a little bit more strange so it's looking for all causes out of a readmission and but the calls for that second admission and we're seeing there and again here is where i had mentioned that roughly 2% and 40% of the cost and just slightly the area in the risk also caused a restatement with some of these members but the numbers and the summary and as you can see the pop laying driving 37.7% and a

lot of what we see in that population i think such as carn aarti and renal failure and some and it tends to impact newborns so that is some of what our healing areas here are happening. we have different stratifications and between and maintenance and your non strategy and as far as the acute flare ups, that's increasing episodes over period periods and we want to make sure these conditions are being well managed and it's presumely and an admission so opportunities there and and again the vast majority is one in that list and it's not especially drug and all the others are especially drugs

and that what we've been seeing year in and year out. and finally, just a look at how our scripps and our amounts by the scripps. in the interest of time i'm moving forward to a quick view of some covid-19 data and there are caveats with this data and that we are trying to capture as much information as we can to give you all insights and it's top of mind everywhere about what we're seeing and also, there's been significant testing that is happening in san francisco under the city test sf program and so, we may not have

that information coming through our data base at this point and so this is probably highly likely under reported and that is it might be that we're seeing less of the testing in san francisco that is coming through claims for our health plans only because the city has done such a good job without making testing available and it could be that view of it so it's not necessarily and the city is doing a good job managing it but it it does not mean we're having a more severe cove situation it's just where the data is at right now and we wanted provide some kind of numbers to look at in terms of what we see in our data in terms of testing and we've got just under 1,300 and we've got 43 folks in this population in our claims that is

having the claims data and of course, i know is probably very small, it's small for me and i'm in front of my computer to look at but this is a age band down there and you would expect as you go over to the right, your population is getting older so that's where you are seeing that patients by age group so as we get into some of our older populations. here we're just looking at impacts on your pmpm net pain in several areas so, we are are seeing -- so this purple line and the pop line is the 2019 data and the blue-line what we're seeing so on the 2020 data so we are seeing dips. it's what we were anticipated with we don't have individuals necessarily accessing their care or our pharmacy not as much of a

dip and i know a lot of us are able to get our meds through using our apps and ordering them online and as far as people coming in for their services we see it happening there and some other settings where we see the same thing and a drop off in or e.r. visits and admits, and even our preventative healthcare visits. taking a look on our medicare population, so here we have about 23,480 medicare retirees and then with their dependents our total is 29,447 and their average age is 74.5 with i mention this in the summary notes but, as we look at the admits and the visits to the e.r., those have dipped over the previous period. again, it's just more of an indication of what is happening

because of covid and not necessarily because we've been able to avoid visits to the emergency room or steer people into other settings of fear such as clinics and the like. only because this is very different from what wove been seeing with every other time period as we trend forward and so, it's definitely an anomalies related to covid-19. and again, here is the chronic conditions prevalence for this population. the same conditions that the pop continues that impacts our non medicare population are those that impact our medication population and the hypo ten shall of liberias and low back pain and copd and what wove got going on there and the quality markers are down and normally we like to see down.

we'd like to see there was less readmission and less avoidable admission and less e.r. visits but i believe it's this covid and here is a look where your membership again and struggle are or in crisis and the conditions that you really see that are prevalent in the population, interestingly enough, goes back to the previous slide where we were looking at chronic conditions because it's the hypertension and it's the osteo arthritis that part can be in the low back

pain and its respiratory dis soared we saw that with the copd so it's happening with our medicare retiree population this is some of the scripps and we don't have the financials on our medicare populations so we say that in terms of the scripps and the day supply that has increased over previous period and i'm glad people are making sure they have their medication and their conditions and we're all the sheltering in place and just a quick look at the population in terms of covid. i do have to apologize. i didn't catch in in time for what was published and this report was generated using financials and we don't have financials for the medicare population it skewed what happened to this report and we'll get corrected information out there and i don't have kipsa readily available but we get a monthly report from united

healthcare and for the population and because it's the tenth, i haven't gotten the new report yet. at the time we knew we had 118 confirmed cases in the medicare population with another 25 people that are possible or probable. we're seeing the exact same trends that we were seeing with the non medicare population which is again that decrease in the utilization as a result of covid and all those are down pro ven tive visits are down and that is where we're at. and i believe that brings us to our final flight. at this time, he will turn over to if there. >> sorry there any questions and

regarding this comprehensive presentation and i want to remind us how you generate the categories of the chronic and unable whatever and is it only from claims basis data? >> yeah, exactly. and the it's using our ibc they've programming logic so it's using their definitions and i know i've spoken to this before there's just so much in that data base to try and remember every single formula because some of them are complicated and it was certainly looking at it's taking scores and age and a look at conditions

that we're seeing coming through on the claims data and you are right, it doesn't have any either and people coming in and getting any care may have conditions that put you at risk and we wouldn't know about it and there's limitations for sure. see any fans waving or electronic hands up so i know it's tough at this point and when you make a brief summary and we as board members and should be thinking in terms of the future and you highlight some conditions and such as low back pain and in terms of we should address and likewise, i would just ask the board members

to look at the list of the most expensive and drugs and look at what is advertised on television and half of them are being advertised on network tv and think about the impact of that as well. and answer and question certainly. there's a point where a patient considerably it's really under the make sure that their care is managed. what we can do and through education and engagement, right, is drive people to the lower cost setting so they're not going to the e.r. and they're avoiding those acute flare ups on their conditions and so we can work in partnership with a plan and also our members are on education. are they going in and getting their visits, staying up on their medication and we can

certainly analyze and see if we see people are filling those scripps and using them and refilling them in timely manner helps us have a clue if they're managing those conditions and we definitely want to make sure people are going in for their preventative and we want to make sure we're trying to keep people healthier longer as much as we can do, it's a complicated world and health-care system so understanding how to act their care and definitely things like the avoidable omissions and the acute fair ups and all of those things and yes, some of those kind of conditions we may not be able to avoid and some of them are lifestyle-driven and i know through our well-being program, and partnerships with kaiser we've done things around disease, you know, prevention,

diabetes prevention and certainly some of those types of conditions that we can avoid onset or delay onset and areas to focus on. >> this is much of this is addressed in our strategic plan as to how we will identify high cost high prevalent and at different points of service and healthcare delivery systems so this is yet another presentation and so i know that push for time and this afternoon how we can update this board at a on that and initiative. >> seeing no other comments in the board we can go ahead for

other comments. >> >> thank you president. we will hold for 30 seconds to wait for callers to get on the line. >> good afternoon, we have no callers on the phone at this time. >> seeing no callers, public comment is now closed. >> we'll close this item and move on to item number 12 which is discussion item as well. >> again, item number 12, report on covid-19 financial updates discussion item. >> good afternoon, commissioners. mike cart with am and board secretary if i could ask you to

give me sharing rights. this afternoon i will share a cedrika update for th --remindid during the august 13th health service board meeting we provided general updates at that time which included an analysis of reduced health plan claim costs during the march through june 2020 period during the shelter in place and stay at home months. due to federal factors but not limited to help practitioner practice temporary closures, deferrals of elected procedures and certainly care avoidance

with expectation that's some deferred care would return in the second half of 2020 but still too early to tell how much that will impact levels for the remainder of 2020. and this is a chart that we displayed last month and just showing very similar information to what recommend just shared for the medical plans and also including a deeper level of suppression as we'll see those purple and the dark blue-line at the very bottom of the page representing dental plans and vision plans. i will report that based on the most recent information i've seen and hhs plans we're seeing a return to, i would say normalcy in the july period and we've just gained access to the june information for kaiser again for kaiser in june and returning to somewhat normal levels after suppression in april and may. so, the claim levels are generally coming out of

suppression period at this point in time but certainly we did see suppression impact the plans in april and may. so today's discussion is going to focus on premium and administrative refunds and invoice crediting that some hhs health plans have offered given the claims suppression impacts that were evidence during the covid-19 pandemic specifically the shelter in place and stay at home months. i will be making a presentation next, after this one that, makes a recommendation for health service board action on proposed delta dental in direct correlation to some of the premium refund actions that i report in this document by delta dental. first for medical plans, the united healthcare medicare

advantage ppo plan, which is fully insured, has returned one million $5,650 as a partial premium refund from the april and may timeframe that will be applied to the september invoice. so, that is the one medical plan action that is being taken by a sfhhs health plan. for the dental plans, there's been actions by both delta dental and united healthcare. for delta dental active ppo plan which is self-funded, so your essentially paying claims and administrative fees, delta dental has offered a 25% of administrative fee service interest and it will apply to the august 2020 and september 2020 invoices and this translates to 73,000 and and 3:00 po plans and also the delta

care u.s.a. and which is offered to go become to employees and retirees and these plans are fully insured and fully enfired premium rates and delta tental has 25% of from the august 2020 and? the delta care u.s.a. and and 710,000 for retirees and the vast majority of which is for the delta dental retiree p.p.o. plan and 690,000 of this amount with the remaining 20,000 and attributable to retirees. and then fort united healthcare dental and offered about employees and retirees which is fully insured and united

healthcare returned 50% of may 2020 premiums and it's the exact amount $19,227 and on the hhs in july of 2020 and split this a lot was 11,751 and 7,976 for retirees and no health plans have premium or fee refund potential at this time. some plans who are refunding these amounts of gives them covid suppression are funded mostly or all by the employers. the one exception to this is this reretiree dental plans, for each plan, members pay the full premiums for those three retiree dental plans so you can see in the table below the allocation

of the plans who are offering refunds or credits by self-funded plans versus fully insured and then by who funds the premiums or the total cost for those plans. so, for delta dental active ppo it's the one self-funded plan that is offered some form of amount credited due to the covid-19 claims question and you will see that plan is funded by employers and in my foot note, i say 9% of total cost rates in 2020 are paid by members contributions, the remaining 91% of costs for the delta dental active ppo plan is paid for by the employers. the rest of the plans in this discussion are fully insured. you will see on the left side of the page, the hmos are funded by the employers and ppo plans

for rye tire's is funded mostly by the employers with an distribution of 9% funded by the ploy and he is 11% paid by members and on the right side you will see the dental plans funded by retirees. you see these amounts and the health plans, the delta dental ppo and usa and the uhc dental hmo for active employees. for plans where they pay all the planned cost the three retiree

dental plans, the delta dental retiree and shared premium rates for the total 2020 year for the that is prize to both retiree dental ppo and the retiree so i will be addressing this speckses ospecifics about this after this one and for premiums that are returned for the united healthcare dental hmo plan for retirees and they will distribute checks to enroll's for 50% of one month 2020 premium based on the tier elected in the united healthcare dental hmo plan so uhc is already credited 8,000 in july

and there are 800 retirees elected the hmo so this will average $10 per retiree in this plan and the specific amounts for each will be based on the tier elected retiree only and the first in 2012 it had a 2% profit pledge which was against the premium payment where this was fully insured in 2012. a second instance when the

affordable care act provided an early reinsurance program and those amounts paid by the federal government, were part of that early retiree reinsurance program in january of 2013, the health service board approved disability tres uting funds based on a premier percentage by all members and adopted a policy that the funds would be applied paid by a number. you have a zero dollar premium and in june of 2013, they subsidized the only employee and so unions that agreed to the 2015 flat premium contribution strategy where the erp funds, partially funded the subsidy. the current circumstance of credit and refund and response to covid-19 claims depression or more similar to what i described at the start of this the slide with the 2% where the returned

amounts applied to offset to planned expenditures so that concludes my presentation and i'm happy to field any questions you all may have. >> i want to remind the board members this is a discussion item only. we'll have another item where we look at revised 2021 delta dental retiree rates. are there questions from the board? i don't see any raised hands electronically. with that, i think we can move and ask for public comment. >> thank you, president. we'll have our 30 second delay time and bring up our slide.

to get on to our public comment line and our moderator will update us. >> thank you, board secretary. we have two callers on the phone line. zero callers are specifically entered the public comment queue at this time. we'll wait a few more seconds. callers dial star 3 now if you would like to join public comments for this item. commission secretary, there's still no callers in the public comment queue at this time. >> thank you, moderator and president, seeing there are no callers, public comment is now closed. >> so this closes the discussion item 13 so we can move to agenda item number 14. -- i'm sorry, we closed 12 and move to number 13. my mistake. >> thank you. and we'll wait one moment while

our presenter privileges are moved over so we can read our agenda item. >> one more moment. agenda number and delta pro

viced 2021 rates and renewal. here is an action item and they will be pressed back to mike. >> mike clark. i will begin to share my next presentation. >> so in this presentation, i'll be presenting a proposal for revised 2021 rates baits on the discussion we just had in the prior presentation. is our profits for today's discussion is there's been suppressed impacts during covid-19 pandemic, especially impacting dental plans but also in response to discussions that occurred during the may and june months. we are also presenting recommended enhancement ppo mile way benefit for active employees

and retirees. and so, we have throw recommendations for health service board action today and the first on the delta active p.p.o. consider this benefit enhancement that i'll discuss and the second is for the delta dental retiree ppo discussing the benefit enhancement as well as a rate reduction revision from rates proved during the june health service board meeting and the third is for retirees and the delta care u.s.a. dental hmo plan and for reference purposes i will not go through the appendix material from this discussion but we include commentary on member contributions in the appendix and as well as a plan design for all sfhhs dental plans for active employees and retirees.

it was a process for today's discussions the 2021 dental rates for all h employer and retiree dental plans were approved by the health service board on june 11th, 2020 but there are two development that brings us to our presentation today. so first further investigation on planned you know for the dental smile way benefit that leads to today's recommendations to enhance the coverage level for members qualifying and where these updates would a reply to active ppo and retiree ppo plans and the second, based on my prior discussion are fee returns by hhs dental plans in the recent months and substantial and that occurred since march 2020 due to the impact of the closed dental due to the covid-19 pandemic and the next

page shows for the dental plan specifically for active employees and retirees now updated information covering through the month of july, which illustrates for both plans the self-funded active employee plans as well as claim dollars for delta dental for the retiree plan that the first two months of the year track close to the prior year where the percentages on the chart are a comparison of the same month per member claims of 2020 versus the same month in 2019. for instance, the january data points for both active employees and retirees are the 2020 claims dollars on a per-member basis as a percentage of the 2019 claim dollars and you can see pretty closely tracking for january and

february. starting to see a drop off in march, april and may, were the suppression impacts and where the claim dollars for both the active employees and as low as 10% of the prior month and the year 2019 starting to rebound in june and in july, we are seeing higher amounts relative to last year and you can envision with members starting to catch up on dental services that may have been suppressed during the spring months. this presentation focuses on the two delta dental retiree dental plans with recommended revisions to the 2021 premium rates for the retirees who pay the full amount of their premiums. electing the delta dental retiree ppo and retiree delta

hmo plan based on these two developments i outlined previously and today's recommendation also include discussion on updating the active dental ppo plan with a benefit improvements way that i discussed. so ultimately, these are the recommendations that will bring to you the conclusion of my presentation just illustrating them here and so you can see that i'll talk through the active employee den ta dental ppo and the retiree delta dental ppo and the usa plan. >> you have quite a presentation here and so if you can sort of move through quickly and the highlights as we head a chance to review all the board members and it's been posted and just move ahead. i appreciate it. >> will do i reviewed this information previously so i'll skip this slide and just the

thought that we're going to review a rate revision for the delta dental plans for retirees in lieu of an approach that would mail over 22,000 checks. the amount that are being proposed for rate reduction are equivalent and to the amount of premium credit that is being delta dental for the retirees and please note on your discussion dental for retiree and that amount has already been paid in quoted to sfhhs. so the end result, as see in the second bullet here, before this benefit is 4% lowering of the revised 2021 premiums versus what was previously approved and i'll review those rates during this presentation. for smile way, it was introduced in the 2019 plan year.

the smile way program, as a rewinder, provides additional number for members with rhumatoid arthritis and stroke and you can see in this chart to the right, that the additional coverage includes certain services for scaling and root claiming and teeth cleaning and maintenance. all covered at 100%. as i go to the next slide, slide 12, what's been unclear in the subject of discussion that several board meetings, since the implementation of the feature is how these benefits may or may not apply to the den adenial ppo plan and what we clarified with delta dental while the teeth cleaning enhancement qualified members does not count towards the members annual benefit maximum, which is to the benefit of the member because other services

can continue to accumulate we've discovered the dental maintenance and scaling of root cleaning for smile way qualified members do count towards the annual benefit maximum and very importantly, this means that services who have achieved their annual planned maximum so we're memberring today that the health board approve a benefit change that the claims associated for all five codes above do not apply to the annual benefit maximum and so this addresses the specific issue is it basically would flow

through the claims to the trust which is protected given the large amount of claims stablation in the ppo plan so we are not suggesting a change to the previously approved total cost rates and the plan and there's no impact to what employees will pay for their employee contributions in 2021 as those will remain, as you see here, five, 10 or $15 per month by tier. for retiree there's an expected added premium rate cost of 1.68% and this is netted from the lower retiree revised premiums that i'll talk about shortly. so as we go into the rating recommendations, these are the adjustments that we are proposing to make and this was a

table that shows the original rate change action that's were approved by the board on june 11th and you can see in particular, my yellow highlighted yields for the retiree employee ppo and the retiree delta care hmo and the combination of action that's we're requesting today and resulting in further reductions of those planned 2021 rates. so this is 2021 dental plan meeting and what you will see in the next two pages is the progression to the recommendation today and

building back and this page page 19 contains a recommended rate and recommendations for today for the retiree delta dental ppo and the delta care usa dental hmo where the net result for the retirees is the smile way benefit improvements that i discussed earlier that also are covered through the premium reduction off originally approved 20201 rates for the claims suppression recognition. so with that, i ask that in recommending the staff recommends the health service board a proves the following dental plan design and rating revisions for the 2021 plan year updating the rate actions that were approved during the june 11th, 2020 meeting. so first, for the active

employee, delta dental ppo adopt a smile way future plan enhancemented described in this document to be january 1, 2021 would change to previously approved 2021 total cost rates but with expected to add 1.4% of claim costs and so there's no changes to the previously approved public cost rates. second for retiree dental dental ppo adopt a smile way enhancements described as well as the rate reduction for 2021 versus those previously approved and so approving the rates that i've outlined on page 19 and then third for the retiree delta care u.s.a. dental hmo program and adopt the rate reductions i contained on page 19 for the covid-19 pandemic cause claims suppression. i'll turn it to you for any questions. >> thank you, very much, for that presentation. so i now opened it up to the

board members for comments or questions. >> >> caryn: , i think yo>> karen,. i have questions about active with this smile way program. first of all, with need to campaign to get them to use the benefits they have. which they don't. it's v very small usage compared to what it should be. there should be a campaign to do that. if they don't get this done they're paying for this when they're retired and it's expensive when you retire for your dental care. and the second thing about the active is is there a need for this. i'm looking at the smile way program that scaling and other

cleaning and i mean these don't usually need it until you are a little older and of course if you don't take care of your teeth you will need it for sure. it could be used for something else and in the long run, who does it benefit if the actors are not using this program. this is my big question. when we add a benefit like this, is there a need for it? will the members use it? and do they need this. i mean, i have never needed these procedures so i don't know. i mean, i know some people do but i think more so when they retire. they're older, you know. so that is my question. any time you add a cost at all, someone is paying. and the only person that probably benefits would be the delta dental so i don't know,

these questions should be taken recommendations to be taken and separate motions and with the retirees i have some questions. we just received an e-mail from one of our members thankfully and pointing out that the smile way program and it seems like every meeting that we had, i shouldn't say everyone one but a lot of them, we always had a member who had a problem with the smile way program. just it was not clear and no one was clear who should be getting and delta needs to spell out how one qualifies and that is the still the question and they have a form that can be signed by healthcare providers and client and the programs and as little lag time and there are problems with this program and there have been from the start and people being able to access to or it's

not clear what they're eligible or the providers doesn't understand it and i would like to see these problems ironed out before we add another enhancement of the care, which is adding additional fee to the retirees and the retirees are those who are hit with shoulder and hit the hardest with this dental plan and they are probably the ones who will need it the least and the children won't need this. any kind of an increase for them across the board here, it effects them and the first -- we got a break here and they add something on so they can get the money back again. those are questions i really think before we add extra things on we should know is it needed and how many people are using

the retiree benefit right now? i have no clue how many people are using it and i know that is an issue with some people this whole access issue. >> these benefits are part of the program and the recommended plans is to alleviate the accumulations of services related to the smile way program for the root claiming to the annual maximum for both the active employees and the retir retirees. >> they don't have this plan, do they? >> we have access to smile way today. >> they have smile way. >> correct.

>> we have the active employers and and as far as utilization goes i agree the promotion of the program can be better and it was working with del tal to roll out a campaign this year and we got sidelined by the pandemic. so, that i agree with. >> that all needs to get behind that. not necessarily hhs has to do all the work on this. as i said, they were really poise to do this when the bottom fell out. and they recovered at this point from the pandemic.

it's been difficult. >> so i was confused. i didn't realize that so sorry about that. and if they are using it, then, fine, it's ok. >> but i do question this -- how about the retirees and all these problems that they've been having accessing this or not knowing who was eligible -- this needs to be ironed out. >> we've had a couple of individuals that we've worked throughout the year and some got to this point that and what and they help people and again we

have stymied by the pandemic this year and you are absolutely right and making it clear to people out this works and how to sign up. if it's a challenge. you are declared earlier and talking about how to reach retiree snow squalls a challenge. and one that we're not saying away from but it is real. >> how do we know how many retirees are actually have used this in the last year. >> we have those numbers, mark, i don't know if you have them or we can get them to you and i'll follow-up with it but i don't have them in front of me today. >> it's a very small percentage and there's something wrong there or else,. >> they don't go to the departmentist for a different set of reasons than what the active employees do so dental care in general is under use lighted. >> active are worse than retirees i was surprised to see.

>> people are staying away from infection control reasons so it's a challenge. >> right. >> well it's before that the incoming members. preventative case has not been that good. no one really likes going to the dentist. it's understandable. >> let's ask her for question or comment. >> hi. thank you for that presentation. and i guess my question ultimately goes to the cost and future years this year we're getting some sort of a break from delta because of the covid pandemic and the reduction in premiums and we're take to take advantage of the decrease to

improve certain benefits by thinking about the out years and how that will effect our premiums and costs and when we're not enjoying the windfall of a pandemic refund. >> thank you for your questions, commissioner. >> it's a 1.86 projected claim increase from delta dental for the retirees for the smile way future enhancement. again, alleviating for retirees as well as active employees the application of services for per services to a couple late towards the annual maximum which is created issues with members in the plans and still continuing to utilize services an annual maximum is achieved to all of those costs fall to them sorry for instance m. of us added spot way benefits really

doesn't become a benefit was prior services accumulated towards an annual maximum. so the 1.86 increment on the retiree premiums is now going to be included within the premium for 2021 and so in a sense there's no incremental adjustment for 2022 or future year rating because it would be embedded in the 2021 retiree ppo premium. >> it's been evident to us as a board and we've been addressing and having this addressed at least for a couple of years trying to point out that it's not in the health plans or members' interest to not utilize services that are available to them and so i think that the

necessity of -- because they have a fund access based on under utilization and so we need to keep address north for sure. i don't see any other -- >> members of the board and abby and holly i apologize i need to hop off this meeting now. does that mess up the quorum? >> i think we still have a quorum. >> great. >> i would like to make the motion we adopt the recommendations as delineated by mike clark and that would be on

page 20 am i correct, mike? >> one second. >> so moved and seconded. with that, we'll open it up for public comment. i would like to note, the letter that commissioner referred to should be available, i'm not sure what the mechanism is but we did receive a letter regarding this agenda item yesterday and hopeful low that will be made available as part of the public comment. in the future we should discuss procedurally how to manage that. >> we should open it up to public comment, i appreciate it. >> thank you president. our moderator wil