favor of accepting the recommendations as addressed, please signify by saying aye. aye. opposed. thank you, it passes unanimously. if we can move on to agenda item number 13, also action item. >> clerk: thank you, president. agenda item number 13, review and approve 10 county survey results. action item. >> thank you, commissioners, this is larry lou c.f.o. for san francisco health service system and i'm here to give my clerk a reprieve from the presentations. i'm here to present to you the recommendations for the annual 10 county survey results that is set the average contribution policy as is dictated in the city charter section a8 dock for

23. and if i began, i actually wanted to give a special recognition to mike clark who has over seen the last couple of years and especially to yuri on our staff and he has been turning out the multiple years now and it's been important to the policy setting but with that, the detailed report is part of your board packet is not available on our website and it's a continuation of on going monitoring for the average contributions of the employers for the 10 most populous counties in california and they set the average contribution levels so based on that study and based on which our methodologies have in the years

and looking the contributions and get forward as part of the established process, our recommendation is to have the amount of $757.31 as the monthly contribution amount and this is a 3.86% increase from the prior years recording and $729.19 and so with that, i asked the board to approve the recommendation. >> mr. president. >> president follansbee, md: yes , commissioner scott. >> i move that we accept the recommendation as presented. >> i second. >> moved and seconded. we accept the recommendation is

there any other discussion on this item from the board members. if not, i ask that we go on to public comment. i'm sorry, commissioner hoa, did you have a question or comment? >> no, i was the person who seconded. thank you. >> president follansbee, md: ok, thank you. going to public comment. public comment will be available for each item on this agenda and each speaker will be allowed three minutes to comment unless the board has new time limits. all public comments are to be made that has been presented and as a reminder the caller may ask questions of the policy body but there's no obligation to answer or engage in dialogue with the caller. state your name clearly and when you are throw minutes has ended i will thank you for your comments and you will be placed

back on youth and they will unmute the next caller. channel 26 and sfgovtv are streaming the number across the screen. opportunities to speak are available by dialing (415)655-0001 entering 146 158 4783. press pound and pound again. you will then enter the meeting on the public comment call line. before we begin public comment, we'll take a pause to allow time for callers to dial in using the information on the screen. after the pause, dial in and wish to speak on this agenda item specifically dial star 3 now to be added to the public queue. when the system messages your line has been unmuted their your time to speak. for those on hold wait until the system indicates you have been unmuted. unmuted

>> just checking in if our moderator is seeing callers in our public comment queue? >> thank you, board secretary. can you hear me clearly now? >> clerk: yes, thank you. >> wonderful. we have seven callers on the phone line. zero 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 the specific agenda item. we'll wait five more second and close public comment for this agenda item.

>> clerk: there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee, md: th. so at this point i would like to call for a vote on the recommendations to approve the 202110-county survey amount of $757.31 monthly to be utilized in determining the employer contributions. based on this survey and all those in favor. >> aye. aye. >> any opposed? it carries unanimously. if we can move on to, thank you, very much, for this mr. lou, very much. we can move on to agenda item number 14. >> clerk: thank you, president

follansbee. review and approve p. p.c. december 31st, 2020 rate stabilization fund. this is an action item. >> thank you to chief financial officer lou for this brief break. we enter the rate stabilization portion of the agenda the next three items will deal with rate stabilization updates starting with the p.p.o. city plan. so this is an annual discussion that we have with the health service board on each of the sec funded and flex funded plans. as back drops, there are throw e different reserve policies with the service board for sfhhs plans. this will deal with the third on the page stabilization. we discuss the ivnr reserves at

the january meeting. for stabilization and the financial gain or loss and self-funded plans calculated annually of december 31st which is the last day of the plan year so for today we'll discuss as of december 31st, 2020. the recommendations for the p.p.o. city plan will be to approve a surplus amount of 330,000 to be amortized as a rating buy down across all rating tiers for the p.p.o., city plan and city plan and voice not available for plan near 2022 applied proportionately per policy between active employees and early retirees and that creates a remaining surplus carry forward balance for 2023 and beyond of 660,000. and i will explain how we derived those recommendations. the city plan rate stablation

reserve is december 31st, 2020 and if you look at the stablation amount itself and how it differs from the present year, today there's a rate stabilization deficit of 117,000 or 117,000 was applied into 2020 rating and 744,000 in buy out was applied for 2021. which meant that after last year's discussion on stabilization, one million 489,000 was carried forward in a deficit and for rating to apply in 2022 and beyond. we are moving from a deficit position to a surplus position and i'm sure it's no surprise, based on just we reviewed with the p.p.o. city plan 2020 experience and given the reduction and over all claim levels due specifically to

medical claims suppression that was observed in 2020. and so the 1,489,000 carry ford deficit will turn no a 990,000 surplus balance as a result of 2020 experience to carry into 2022 and beyond. policy is one-third of this rate stabilization amount for 330,000 would be applied in 2020 plan year rating. in the last paragraph, you will see the $330,000 rating buy down figure will represent 6/10 of a percent of the early estimated 2022 plan year p.p.o. rates and that will be confirmed and determined for finalization as we present the rating recommendations for the 2022p.p.o. plan during the may 13th health service board meeting. this page shows the comparison

between original expectations for cost, the claims that the expense and prescription drug rebates and the buy out applied in 2020 rating compared to the right column, showing the actual experience for the p.p.o. city plan for 2020 and how you can see, especially because of the line 1, the claims being lower that leaves to the surplus to be carried forward and ta surplus, as you see here, offsets the current deficit carry forward and produces a stabilization reserve surplus off which one-third of that is recommended for application and 2022 rates. so, with that background, today's recommendation is recommended for the requirements of the health service policy

that the surplus amount of the am ar tiesed as a rating buy out across all rating tears for the plan and p.p.o. city plan choice not available for plan year 2022 and purchase there's further information that i will go through on recent plan stabilization actions and president follansbee. >> president follansbee, md: th. any questions or comments before i move on to request a motion? >> this is commissioner howell. i have a quick question on the math. so, can you help me understand what that $744,000 figure is from? >> sure. so this is actually, because wore doing the calculations based on 2020 experience, relative to 2020 the deficit

carried forward in what applied. there's the current plan year which had a deficit position and so wore accounting for the fact that we've already applied 744,000 from the december 31st, 2019 carry forward. we've already a employed that in 2021 raids. >> i see. so you are put reapplying it back. >> exactly. we just have to account for that of the figure complicated by the fact that we're always looking one year backwards at experience to project to experience one year forward with the stabilization adjustment and just have to recognize what we enacted for 2021 since that is in place. >> great, thank you so much. >> thank you for the question. >> president follansbee, md: any other questions or comments?

i'll entertain a motion. >> this is chris canning and i move we a covid the p.p.o. rate stabilization as presented. >> second. >> thank you, very much. it's been moved and seconded that we approve the recommendations of the claims stabilization policy and apply surplus to the buy down across all tiers. any other questions or comments otherwise i'll open it up for public comment. hearing none, i'll open it up for public comment.

>> you are on mute. >> thank you. public comment will be available for each item on this agenda. each speaker will allow three minutes unpresident the board president deems new public times during the meeting. they are made available concerning the agenda and that is presented. as a reminder, the caller may asks of the poll sew board but there's no obligation to engage in dialogue with the colleagues and i welcome you on the call you are encouraged to state your name clearly although you may remain anonymous and i will call you for your comments and the moderator will unmute the next caller. channel 26 and sfgovtv.org are screening the number. opportunities to speak are available via phone by calling

(415)655-0001 and (415)655-0001. and entering access code 146 15 4783. press pound and pound again. you will then enter the meeting as anna ten dion the public comment calling. before we begin, we'll take a pause to allow time for callers to dial in use the the information on the screen. if you dialed in and wish to speak to this agenda, dial star 3 to be added and the system message, this is your time to speak. for those already on board, continue to wait and until the system indicates you have been unmuted. our moderator will notify us with any callers in the public comment queue. >> we have seven callers on the phone line. if you have callers that entered the public comment queue at this time. a reminder to all callers on the line. you must dial star 3 now and if

you want to join public comment for the agenda items. a reminder, to please go on mute and we are hearing a little bit and we will wait five more seconds and close public comment for this agenda item. >> there's still no callers in the public comment queue at this time. >> clerk: thank you, hearing no further callers, public comment is now closed. >> thank you, very much. i'll call for a vote on the approval of the stabilization fund recommendation as outlined. all those in favor. >> aye.

>> president follansbee, md: op. it carries unanimously. thank you, very much. we can -- we go onto the next agenda item and we'll entertain a break after this agenda item so if we can move on to number 15. >> clerk: review and approve blue shield of california flex-funded hmo plans december 31st, 2020 rate stabilization fund. this is an action item. >> i will call up the presentation for the blue shield stabilization. so, again, this is an annual presentation and same entry as a last discussion and similar results to our last discussion

given pandemic influence health claims suppression and we will see an increase in the surplus amount and today's recommendation is for the requirements of the service board to approve the claims stabilization surplus amount of 4,856,000 to be amortized as a rating buy down across all rating tiers for the plumas shield hmo plans for plan near 2022 by policy between and retirees and is that will leave a remaining surplus carried forward for 2023 and beyond of $9,007,000. and the reserves and it was presented earlier this year and you can see the requirements of the health service boards plan stabilization. for most years since the plumas shield hmo was flex funded in 2013, there's been a deficit position on the plumas shield

stabilization. with favorable experience with the 2019 plan year relative to plan rates, the deficit flipped to a surplus position as of december 31st, 2019 and so that led to a rating buy down in 2021 rates and 2,562,000 and the carry forward to be applied in 2022 and beyond, it was 5,124,000 so the added surplus will be added to that for our recommendations on the rate stabilization balance for the plumas shield plans for 2022. there's a projected surplus now of $14,567,000 to carry into the 2022 plan year. we illustrate those calculations and that leads to one-third of that amount per policy or 4,856,000 to be recommended to apply as buy down in 2022 rates.

that figure represents 1.4% of the early estimates 2022 plan blue shield rates and when we review rating recommendations for these plans and during the may health service meeting. similar to the uhc ppo information we looked at, lower claims and line one are essentially the driver of the result much lower claims than expected due to pandemic influences. and so, with that, we show here on the top part of the page the calculation of taking last year's stabilization surplus offsetting the amount applied in 2021 buy out and so we have the prior sur lus bias plus the added surplus balance from this

cycle and leads to a total stabilization surplus of which we recommend one-third be applied for body 2022 rates so with that you see the lower box it's recommended per the requirements of the health service board approved stabilization policy that the surplus amount of $4,856,000, the amortized as a rating buy down across all rating tiers for the active employees and retirees for my questions or discussion before asking for a motion? >> mr. president, i move that we accept the recommendation for

the surplus amount of 4 million plus the am ar tiesed as a rate buy down across all the tears for the plumas shield hmo plan for a plan year 2022 the recommendation. >> so moved and seconds that we apply the simple amount of $4,836,000 as outlined in the recommendations and any further questions or comments before i open this up to public comment? hearing none, go ahead and open us up for public comment.

>> caller may ask questions of the policy body but there's no obligation to answer or engage with the caller. state your name. when your three minutes have ended up thank you for your comment and you will be placed back on mute and we will unmute the next caller. channel 26 and sfgovtv.org are screening the number and opportunities to speak are available via phone by calling (415)655-0001. entering access code 146 158 4783. pressing pound and pound again. you will then enter as an attend'. we will take a pause to allow time for callers to dial in using the information on the screen. after the pause callers if you

dialed in and wish to speak on this agenda item, dial star 3 now to be added to the public comment queue. when this system message says your line has been unmuted their your time to speak. for those on hold, wait until the system indicates that you have been unmuted. our moderator will notify us of any callers in the public comment queue. >> we have a caller on the phone line but zero callers and to at this time and another brief reminder is i'm hearing a echo. can you go on mute. thank you so much. a reminder to all callers on the line you must dial star 3 now if you want to join public comment for the specific agenda item. we'll wait five more seconds and close public comment for this agenda item.

>> there are still no callers in the public comment queue at this time. >> thank you, moderator. hearing no further callers, public comment is now closed. >> president follansbee, md: th. now i ask for a vote on the recommendation as outlined in the presentation. all those in favor say aye. aye. any opposition? hearing no opposition, it passes unanimously. >> mr. president, may i make a suggestion if the board is willing to go along with that we take the next two items and then take a break? >> i'm happy to entertain that possibility. it takes a while to move into closed session that would be fine. if i do hear any of that, we can

move on to item 16. we can move on to item number 16 please. >> agenda item number 16 is to review and approve delta dental self--funded active employee p.p.o.2020 claims in utilization experience and december 31st, 2020 rate stabilization fund. this is an action item. >> mike clark. i will share the discussion guide. it was an unusual year for dental experience.

i'll walk through what the claims suppression impact for the dental act employee plan and how that translates into our stabilization recommendation. you will see the recommendation and i will ask you to approve today involves two elements. first to suspend the self-funded stabilization reserve policy on a one-time basis for the delta dental p.p.o. plan and approve use of two-thirds of the december 31st, 2020 stabilization balance or 12,229,000 to be applied towards buy-down across all rating tier for the delta dental p.p.o. plan for plan near 2022. this would leave a surplus carry forward balance for 23 and beyond of 6 million and 114,000. and i stress the bottom of this slide that today's presentation recommendation is stated by is

for active employees and we will be doing a thorough review of 2022 retiree dental and plan renewal and experience and our next health service board meeting on april 8th. and we've already discussed the prior two presentations the focus on the stabilization policy with today's focus being the delta dental act of p.p.o. plan. and so, the recommendation is actually two-thirds reduction of the stabilization and you will see that's generated by significant claims suppression that we saw in the dental plan and even more so in the medical plans. the loss ratios have been trending towards and we're at 100% in 2019 with claims and fees equaling premiums but because of lower plan claims in

2020, due to dental office closures at certain points of the year, the loss ratio ended 2020 for the active employee plan at 87% so substantially lower than the premiums. what we saw in 2019, was even before the pandemic, about one out of every three lives covered in the delta dental plan did not have a dental cleaning and that statistic grew to half, about 43% of recovered lives in the plan did not have a dental cleaning in 2020. even with the fewer over all services delivered, the distribution by types of carrie main relatively the same. about throw out of four services, 75% of diagnostic and pro ven tive in nature and about 20% of services are related to things like fill, oral surgery and root canal and 5% of surgeries or what is considered

major things like crowns and inlay and implants, dentures and bridges and there is coverage on the plan about 3% of total covered lives services and including 6% of children and i'm not going to review the appendix with you today but there's details month by month and head count information for the plan and the appendix. as i transition to looking at the plan design itself and the choices that members have, there are throw benefit levels for the act of employee p.p.o. plan and the highest level of benefit and lowest member cost is when a member utilizes a p.p.o. dentist. and you can see the deductible, there is none in the active p.p.o. and the annual plan your maximum is the same regardless of what type of dentist you use

from a network perspective but the benefit levels are generally higher for use of p.p.o. dentists generally lowest for use of an out of network dentist. and as that translates to the type of network dentist in this plan, delta dental has two levels of network and it's based on level of plan discounts and a given dentist is willing to accept and the deepest discounts in the lowest service costs are for dentists in delta's p.p.o. network and there is a second level network called premiere where there are discounts but they're lower than the discounts for the p.p.o. network they are not for dentist who chose not to participate in delta p.p.o. network or premiere network. you see the distribution of a

procedures by type of dentist with p.p.o. on the left and premiere on the right. there are throw colors of whereas showing the distributions all which have percentages by color add up to 100% and the plumas bars represent the sfhhs active and the red bars represent the 2020 utilization of services for active employee and the delta dental p.p.o. book of business is represented in the green bars. what this says is the family members and they're using premiere dentist at a much higher rate than p.p.o. dentist which is different than the book of business experience for delta dental over all and we realize a lot of this is geographically driven. we ask delta dental to provide us service utilization

information by county for the active employee population to be able to evaluate the percentage of procedures that are going to p.p.o. dentist, pro mere dentist and non contracted dentist by coun tease so this is based on where the dentist office is, not the member residents but the dentist office, which county and this is information in counties with at least 1,000 member procedures so we know for instance, that the p.p.o. dentist utilization is the lowest among all types of departmentists in counties like san francisco and marin, sanoma, and also higher in certain coun tease in the bay area like solano county or farther out from the bay area and relatively

highway in sacramento county in san jaoquin county. in order to support members attempting to lower their over all cost for dental services, well, certainly promoting good mental health and hoping to see higher utilization of especially preventative care into 2021 members are encouraged to consider seeking care from delta p.p.o. dentist and the member co insurance requirements are less for many services and over all service costs are less given the higher discounts in p.p.o. network versus premiere and we have information here web links to help serve for p.p.o. network as well as pre mere dentist at these westbound links so web lie

history of the stabilization reserve on this plan since the reserve was started in 2014 and it is grown over the course of time. the one-third application per policy for stabilization reserve and the rating applied for the 2016-2019 rating years starting in 2020 and cascading to 2021 and a move to use one half of the new stabilization reserve was applied in rating for this year and last year and because of the large built up of stabilization, especially, now because of the lower use of services and the lower over all claims in 2020, do you to pandemic influences, we are suggesting the addition of about 12.7 million and added reserve

you can see line one in much lower levels of expected claims or actual claims relative to expected. and so what that leads to is a stabilization reserve that is going to continue to grow and by recommending two-thirds of the stabilization be used for 2022 raids or attempting to preserve a carry ford stabilization of about 6 million to be used after 2022 and that is similar to the prior carry ford stabilization reserve that you see at the end of last year the 5,662,000 in the third row of this exhibit. so with that, i ask that the health service board suspend the self--funded stabilization reserve policy on a one-time basis for the delta dental p.p.o. plan and approve use of two-thirds of the

december 31st, 2020 stable as i balance or $12,229,000 to be applied towards buy down across all rating tiers for the dental plan for plan 2022. >> president follansbee, md: th. any questions or comments or discussion from board members? >> yes, i do, i have a couple questions and comments. you know, there's a lot of confusion i think and it was for me for sure between the p.p.o., the premier and other networks and you say that the premier is in network but yet they're out of pocket is the same as out of network so i think it's confusing and i talked to my dentist and she was confused about it seemed like they weren't clear about these different categories either and what is the premium for active

with the family. does anybody know that off the top of their head? >> yeah, the monthly premiums are $15 for a full family for an active employee and $10 if you are covering just one dependent and $5 for single coverage monthly. >> so the city picks up whatever else there is. >> correct. >> they pay you 90% of the cost of the active p.p.o. plan. >> since we continue to have low utilization with pre ven tive care, and so as a result, you have more premiums than expenses so is there ever talk about delta decreases their premiums, their over all premium since but really needs to be done because dental care is important to me. i think that they node to do some serious outreach.

we've had this problem for years, not just with the pandemic, that not very many people are especially since it's quite inexpensive. are actually using the plan so, i think there has to be some kind of push here for delta dental to put out against the information of how important your cleaning is and whatever, you know. because i was surprised, i remember last year too that there was such a small utilization in the actives. utilization seems to be low all the time and what it is low, it seems like the premium should be less too. also, the p.p.o. now is definitely less expensive. there are reasons