president follausbee we are ready to start when you are. >> good. >> i'm going to go ahead president follausbeeil call the regular meeting of the may 12, healing service board for san francisco to order. >> thank you. >> remotely we will go ahead and do the pledge before we dot roll call >> stand for the pledge meeting called to order at 1:02. >>[pledge of allegiance] thank

you very much. go ahead and have the roll call. >> thank you. roll call. president follausbee. >> present. >> vice president canning >> upon present. >> supervisor chan will arrive late >> commissioner hao. >> and commissioner zvanski. >> we have quorum. >>y will go ahead and call for agenda itemly. >> number 3 the resolution allowing teleconference meetings under california government code 54953 this is an action item. will be presented by president follausbee. thank you very much. this is a renewal for 30 days under the current circumstances emergency healing decoloration -- i think

identical to the previous resolutions we approved at every meeting. any comments on the healing service board members? this is chris congressman i move we accept and approve the resolution to allow teleconferenced meetings. >> second. >> we will open up for public comment. >> thank you, president follausbee. public comment in person will being first and virtual for anyone wait nothing person you can prop now. each speaker allowed 3 minutes unless deemed new time limits all made concerning the item presented. a caller may ask questions but no obligation to answer. for those on the line when i welcome you you state your name you may remain unanimous. il give a 30 second warning as your time is ending.

3 minutes have ended i will thank you and tell you your time is up you will be on mute. >> remote viewing available on sfgov and web ex. the number is 415-655-0001. use code 24962959285. >> then pound sxound again. enter the meeting on the public comment call line and star 3 to be added to the queue. when the system message says, your line is unmuted can speak. on hold wait to be unmuted. we'll begin with in person public comment. no one approached the podium. web ex for virtual comment.

we have 3 callers on the line. zer over have entered the queue at this time. all the callers on the lineup you must dial star 3 if you want to comment for the agenda item. we'll wait and then close public comment for this agenda item. no caller have prompted to enter the queue at this time. no callers public comment is closed. thank you very much. moved and seconded we adopt the resolution allowing teleconferencing for the meetings for the next 30 days under code section 5493e. a roll call vote. >> thank you. roll call president follausbee. >> aye.

>> vice president canning. >> aye. >> commissioner breslin. >> aye. >> commissioner hao. >> aye. >> commissioner zvanski. >> aye. >> president follausbee. >> thank you we have the unanimous vote in favor. move on to item 4. >> thank you, president follausbee. 4 is general public comment an opportunity for members to comment on any matter in the jurisdiction that is not on the agenda. including requesting that the board place it on a future agenda item. >> i will read the instructions allowed. in person comment first then virtual. you are welcome to prop now. each will be allowed 3 minutes to comment unless the board president has new times. awe commencements on the item presented. caller may ask questions but no

obligation to answer. for those callers on the line when i welcome you encouraged to state your name you may remain unanimous and i will give you a warning when you have 30 seconds remaining. you will be placed on mute and unmute the next caller. remote viewing on line using sfgovtv her web ex. or dial the number. 415-655-0001. >> when prompted use code 2496, 2959285.

no one approached the podium we'll move to web ex for virtual public comment. and we have 3 callers on the phone line. zero entered the queue at this time. reminds to all callers you must dial star 3 now if you want to comment on this item. we have 3 callers wherevero have entered the queue at this time. i will indicate when there are no more callers. public comment is closed. >> thank you very much. >> now move to agenda item 5. >> agenda item 5 approval with

possible modifications of the minutes of the meetings april 14, 2022 regular healing service board meeting. >> thank you very much. i call attention to the commissioners as well as to the public, amended minutes were circulated yesterday. with some typographical corrections made. to the original draft minutes that were sent out last friday. with that, is there any open up for a motion. gimented to page 9, second paragraph last line, president follausbee wondered why members go to costco for eye glasses what was said you were wonder would evering why they were reimbursed less for eye glass

and eye care. that was assuming in terms of reimbursement from the upon yes. you are right. >> okay. thank you. president follausbee i will make the edits in the final posting. i move we approve the minutes as corrected. >> second. move and seconded. minutes modified today. and in the circulated minutes yesterday. the approved, further discussion? >> open for public comment. thank you. for public comment and virtual anyone wait nothing person approach now. each speaker allowed 3 minutes unless there is a new time limitful made concerning the

item presented. the caller may ask questions but no obligation to answer and engage with the caller. when i welcome you, state your name although you may remain unanimousism give a 30 second warning when you have 30 seconds waiting. remote viewing online using sfgov.org and web ex. dial the number on the screen 415-655-0001. when prompted use 24962959285. and press pound and pound again. enter the meeting on the public comment line and dial star 3 to be entered in the queue. when your line has been unmute third degree is your time to

speak. >> we'll begin with in person comment. no one approached the podium we'll move to web ex. we have 3 callers on the line. wherevero enter the queue at this time. reminder that you must dial star 3 to join this public comment. we will have wait 5 more seconds and close public comment for this agenda item.

>> thank you, roll call president follausbee. >> aye. >> vice president canning. >> aye. >> commissioner breslin. >> aye. >> commissioner hao. >> aye. >> commissioner zvanski. >> aye. >> it hen approved unanimously. and now move to agenda item 6. >> agenda item 6 president's report. >> presented by president follausbee. >> thank you very much i have no formal report to acknowledge most of us are aware that now reached over 1 million 3, 5 huh human deaths from covid.

the lag in reporting looks like we will reach the peek of new case that we saw during this week that we saw last year as well. and i appreciate everyone's efforts. and remind all of us if we have been vaccinated with initial series that about 70% of san francisco received one boost. and there is a lot of talk -- no audio. president follausbee we lost -- sound for a second. hang on a moment, please. can you hear us now? president follausbee. can hear us. >> thank you for witting just

a moment. i will unmute you. >> yes, thank you. >> sorry for the disruption. thank you. okay. you can hear me. >> yes. clear. >> when we finished with the item i'm concerned because i got a not ifkdz that we closed the practice session. i'm concerned the public was not allowed address earlier agenda items. agenda item 4 we were in a practice session, i believe. if we were then after we finish this item we may open up for public comment and allow public

to comment on this and any previous items to make sure everybody had a chance to speak i apologize if well is confusion. so -- just to finish. that you know san francisco is approaching the peek upon this week. of new covid case i recommend you lookament the city and county website on covid which has instructionos measures to take to minimize the risk of occurring covid. it is not just death we worry about but masking and if you are eli didn't believe for a booster to consider getting a booster. there are reports that various vaccine manufactures coming up with modified shots that may have broader range and ac50 with

the current boosts. that are available. do cover limp the circulating viruss that are in the bay your and the united states. with that. i would like to turn the mic to commissioner zvanski who wanted to comment about on the passing of a former board member. the health commission. mr. james michael. would like to comment now. >> thank you, president follausbee, i would. >> jim was a police officer who served on the board from 1987 to 2009. and actually very distressed when i locked at his date of birth he was younger than i am. not much but enough for me to be even more saddened at his

passing. jim served this board limp he was born and raised in san francisco. went to polytech high. and i don't remember he mentioned joined the sheriff's department before the police department. but he served well most low at cent roll station. and then during his time on the board he served as the chief public information officer in the early -- 2000's. he had a great sense of humor. good guy. a lot of fun on the board. and i remember that he had a wornful family and maryellen his wife was good support of the great kids and he used to go to some of our conferences for the international foundation of benefits they were always a lot of fun to be with. and he was very, very concerned about our member and worked hard

regardless of when contracted him for assistance. took his job seriously and one of the nicest and best served not only the city at large especially as a police officer but his service on the board. and he is missd and i don't know commissioner breslin do you have anything to add to that. you knew him as well. >> nothing further. >> thank you. >> great guy and we miss him. thank you, president follausbee for the opportunity to memory yellize jim. it is always sad when we lose our colleagues he served the city well and us well. thank you. >> thank you. no other comments the president's report open up for public comment. and again assuming that the public minot had access when i think we were in a practice session, if the publicments to

comment on earlier items would allow that as well. >> president follausbee i have been in communication with sfgov.org the broadcast was live from the beginning. if you like to have a web ex the opportunity in -- to for the public to comment we can do that as well. >> i will add that i think to be absolutely sure. again i did get this notification. we were closing the practice session by the time i within mute. apparently. i think i will do that in case. we'll see and move on to the next item after that. >> thank you very much, president follausbee. in person then virtual. approach the podium now. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then #

1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

no one approached the podium we'll move to web ex. there are 2 callers. 0 have entered the comment queue. you must dial star 3 if you want to join public comment for this item. we will wait and then close public comment for this agenda item. we have 2 callers on the line. i want to check with one caller may have raised hand and put it back down. welcome. would you like to participate in public comment?

s no. public comment is closed. >> thank you very much. this closed 6. we am move to agenda item 7. >> thank you, president follausbee. item 7 the director's report and presented by executive director aby. >> good afternoon. commissioners. thank you doctor follausbee for commenting regarding the state of the current covid omicron variant. like a college essay. anyway, we are hopeful hathis will subside quickly and it is a new world we are in with the state of uncertainty that is difficult to get to adjust to but this is where we are.

thank you. following up from our special board meeting 2 weeks ago or 1? it has been arc while. we did learn a bit from our guest speakers. we are continuing down our education path at our june meeting we have confirmed doctor joseph from united health care formerly called doctor joe. who has been an excellent physician, leader with united health care and will be speaking and doctor michael mason from the kaiser system that kaiser permanente group will speak as well. i'm looking forward to it. i have not heard an update personal low or professionally and the state of health care services. i know doctor joe was at the american conference today. when we spoke of him yesterday.

he had arrived. we will get the latest news and will be informative. in the directory report are additional dates on tracking the time line to bring become to the board in august. that the draft of the strategic plan that i'm sure you will have input. into. and -- will -- have a final version prepared for the september meeting. i wanted to comment that the staff has taken on the responsibility of dog the eligible verification audit. many members were here when this was done in 2018. it was a huge effort. it had not been done for many years. we tried dot entire population or we did.

and with an outside consultant and so -- one thing we learned that to that in by the sized pieces was sensible. that is where we are now. literally this week rolling out the activities to do the audit. on a smaller pilot base i. we can intensely learn from the experience of doing 600 folks in the first round. we'll report to the board how that went. but it is noise we have a mix of staff that participated in the large event. have those experienced to learn from and new staff a fresh way of is a perfect blends. exactly be helpful. at the end of the day when we began this process in 2018. we did anticipate significant financial savings, we did amount and found there were many

importance that should not have been on the plan. and they were removed the savings was real. we anticipated this time there will be a positive affect from that. and that the folks would have stayed off and that anything that come up in the meantime we like low would had a chance of seeing it. the audit will confirm that. and i think it sent a message to membership we were responsible to the board that you were upholding your duties and no fraud. so, i comment the staff for taking it on. it does require a baptist work from all the team the system folks and member services and communication team everyone is on board. thank you. >> i did add in my director's report little responses to in of

the questions we heard during the last meeting regarding the delta pediatric coverage it is looked at and updating there directories. and we are still seek to speak to the members i don't know if we have made that contact. the vsp request about costco and pricing for glasses is described in the report. i did want to take the time to do 2 special things today. one is i wanted to formerly introduce our new chief operating officer. ray? and we are excited. he is in his fourth week. it is good. almost a month. and we are happy top have him here i will let him say a few words we will make arrangements

to speak to you directly. >> good afternoon, commissioners. i'm ray the new chief operating officer. nice ring. i'm looking forward to meeting each one of you and working with you as well as abby and the rest of the team. as well as our part sdmers consultances i pent my career in public service. working for a number of california public agencies in hr. i'm looking forward to using my experience it achieve our shared goal of maintaining quality benefits for members. i promise to assist my team in continuing to provide customer service to member and i'm looking forward to meeting with you and hearing your ideas on how we can achieve it. thank you. thank you.

i wanted to comment for linking together the education session for the strategic plan where doctor derrick talked i thought about the mental health situations we are in and challenged us to think about the 75% of the population that has sprjsed mentalal health issues and how we help them with self care. and really flourish in the difficult times. and in addition, we recognize that may is mental health awareness month and our team our well being team has done work in communications throughout the city's network to lift up the messages about awareness and that has been great. our mayor made a nice video for us. i think was sincere in her support of our department and the services that we provide as well as mentality health awareness in general.

i really -- if pleased we have come to this pointch that we are talking about mental health. i did want to make a special note today not only is it an important strategic initiative to take care of the needs of members and it is menial health month we responsiblesed a tragedy last week where a person a patron took their life at the public library. unfortunately that is the third such incident that occurred in the last several years. our team has been there for everyone. and it is -- i'm myself. i wanted read the note i received the mayor's office receive exclude others regarding service of our program. and representing our program today is janet. here in the audience and her

colleague -- jeff -- lit in was not able to be here but i know he is here in spirit. our department now the 2 folks open position we are recruiting for. with that, i want to read this note to you. i am writing for michael lambert the support and responsiveness provide by you should team janet and jeff over the past 72 hours. written on friday. on wednesday the main library witnessed a tragedy with the loss of a man's life who fell from the 40 floor. my staff reached out to request a response and presence from the councilors yesterday. janet and jeff were here yesterday morning at 8:30 a.m. to engage library personal in 2 sessions one large morning and one smaller afternoon session.

jeff returned to engage with a stable group in our auditorium. the capacity for my staff to be able to grieve together and express feelings and receive guidance and council from licensed professionals who are city and county san francisco colleagues was valuabling to putting my organization on a path of heel and recovery. as you know this is the third tragedy in 15 years in our main library and 5 years in our main library and janet and jeff engaged staff, sharing resource, listen to trauma. i have been moved by the compassion that has been expressed the past company days by your extraordinary team. i'm grateful for the level of support they have provided to the library repeatedly during our time of need. accept my gratitude for the 2 angels have you in your department.

janet i would like to call you forward, please. good afternoon will commissioners. i want to say hafor jeff and i it really is an honor to be able to hear people's stories. and -- how people open themselves up to us. feels like a sacred space.

we feel honored that the library reached out to us and issue absolutely glad and proud to serve. thank you. [applause]. that concludes my remarks. if there are questions from the commission? i want to complement the staff and that hsf staff were working with the mayor and the mayor's office to highlight mental hang awareness month. i'm getting messages from the office regarding mental health awareness month and options for how to log in to take self assess am quizes. they not made a one time announcement but with our staff they have devised a program with remindsers regardless throughout

the mont. they should all be commented for this effort. this month and the year. thank you very much. any comments or questions for the director? i wanted call out -- kerry and ja lisa -- who are the second half of well being and they really come together to work well together well being team. the synergy is there. i appreciate the entire team. thank you. >> thank you very much. we will open up for public comment. thank you, president follausbee. in person comment is first then

virtual. anyone in person approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

we will begin with in person comment. no one approached. we'll move to the web ex virtual public comment. we have 3 callers on the phone lin zero are not guilty queue. on the line dial star 3 now to be added to the queue for this agenda item. we will wait 5 more seconds then close public comment for this agenda item. no caller indicated to participate in public comment. public comment is closed. >> great. thank you very much. >> i wanted add that i think the

first time i did not check the analytics report is green triangles indicating our systems are on schedule with resources, within budget. i think this is great. and should give kudos to our analytic's team for continuing the system and maintenance and updates. thank you very much. >> with that we will close item 7 and now 8. >> thank you, i want to acknowledge that commissioner scott arrived. >> agenda item 8 is sfhsf financial report. as of march 31, 2022. and this will be given by [inaudible]. good afternoon.

results the detailed report is in your package i will highlight items here at the meeting. and we projected results throughouten of the year and the comments i will make are the results for the end of the year. in total trust fund fur year will drop by 3.6 million. the health trust itself will drop by 4.2 off set by enter income bring its up. the claimed experience favorable. we expected the decline is due to stablization it was a planned reduction in our reserves. the clean experience pharmacy rebate and 4 and a half % of spend. we get become in rebates. [inaudible].

the -- health sustainability fund is has predicted bvenls 3.8 million the end of the year. this year projecting the use 680 thousand dollars. and in the general fund we end the year close to budget. we are ahead of plan. for the 9 months. we expect closed budget happy to answer questions. question or comments, commissioners? hearing none. we will open for public comment. thank you, president follausbee. in person comment first and virtual. for anyone in person you can approach now. each speaker will have 3 minutes

to speak. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

we'll begin with in person comment. no one approached the podium we will move to web ex for virtual public comment. we are 3 callers on the line zero have entered the comment queue. all callers on the line dial star 3 now if you want to comment for this item. we will wait 5 seconds and then close public comment for this item. president follausbee public comment is closed. >> thank you very much. thank you for that solid and understandable report on financial status. i appreciate it error much.

now move to item 9. thank you, president follausbee. beyond everagenda 9 is the presentation on the 2022 rates and benefits calendar for year 23 and this will be presented by deputy director. >> good afternoon, commissioners. the rate and benefits calendar coming to the end. we should i amount that we will get through all of the recommended actions here today and assuming that occurs we will be able to cancel the may 26 hold on your calendar for a second may meeting the june meeting will -- go smoothly as well. so -- this point we don't participate needing that second john to hold but keep it in case at this point. that is the only change we will cancel the may 26 meeting the end of this meeting should we

not have anything to carry forward. >> great. thank you very much. good news. should it happen. should -- any questions or comments from the commissioners? we will open up for public comment. thank you, president follausbee. in person comment first then krirt virtual if you are waiting in person you can approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states

“welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity. be no one has approached the podium we will move to web ex.

>> we have 3 callers on the line but no one in the queue. we will wait 5 seconds and then close the public comment for this item. public comment is closed. thank you very much. i should note that when we open up agenda item 9 we opened up the rates and benefits section. of the health service board meeting today. i will call for agenda item 10. >> thank you, number 10 health plan 2023 rate summary early retiree healing plans by mike clark. >> good afternoonful mike clark. so today we will be presenting all of the health plan recommendations for active employee and early retiree and

drug plans leading off with the rate summary discussion item to -- allow to you see how the rates are proposed to -- change in the 2023 across each of the active employee and early retiree healing plans and after this discussion item then i will present for action each the renewals. on page 2 you will see the proposed rate changes for each healing plan. the left side before rate stablization will apply to both canopy care it is the first year, well is no opportunities at this point to build up rate stablization balance and then the kaiser hmo the plan that does not apply to rate stitialization. and the right side you will see the proposed increases for

access plus blue shield. trio and the blue shield accolade incorporate planned experience as well as the rate stablization adjust amless. on page 3 looking at the hmo's brotherly.5% increase for access plus and 5.3 for trio below expectations for both plans recognizing that for access plus favorable experience we'll talk more about the difference and what we observed later in this meeting. and both are aided by increase in the stablization buy down approved by the service board in march. health net canopy care a substantial reduction, 10.4 from 2022 levels. primaryly to a lower projected cost for medical capitation and

canopy care, most of medical costs falls under a captated rate. only emergency care and somance later costs subject. and so relative to the initial forecast that came through the rfp press in fall 2020, 21 when decided to add it for 22, and the health net is able to project a lower cost capitation i will talk about this in that recommendation presentation. for kaiser we see a lower over all rate increase relative to last year. reflecting favorability in the under lying trend assumption that kaiser is including in the under writing for the health plan. on page 4. blue shield coming off of a lower than trends rating that

was driven by benefits that were seen in the rfp process around lower fee and prescription drug rebates they continue o. because we had a lower increase left year those are embedded in the rates and the starting point reflects those we projected 2023. rate increase projects 6% increase expected plan experience which is consistent. with national health trends but the rate stablization change impact because 2022 rating incorporated changes that were an about the from pandemic suppression. going in 2023, we are normalizing the rate stablization adjustment. there is a portion of an increase impact from the stable wragz that was approved last month. just to give a relative sense of

how many active employees and early retirees in the plans we talk about today that is the chart on page 5 you see the majority of active employees and half of early retiree in kaiser. most in blue cheeld plans with health net canopy looking to build that enroll am for 2023 and the nonmedicare ppo plan held stead we enroll am over the years. i will not go through page 6 in detail it is there for your reference to see the reading across each of the plans with the top of the page being total plan rates. recommended for 2023. that will seek your approval on later in this meeting. employer contributions in the middle and member contributions at the bottom of the page. and you will see the column

relationships for the active employees from the 93-93-83 contribution strategy as well as 196-83 and columns to the right are early retirees receiving a full city charter contribution. my last page. president follausbee will open up for commissioner comments is looking ahead to the june board meeting executive director mention in the her director report. there was a potential administrative recommend agsz for nonmedicare split family planned realignment. rearc lining potential low the add administrator for the members from current blue shield under access plus and trio to u nighted health care when there is at least a family member who is nonmedicare in covered today

in -- united health care ppo or the blue shield hmo and one family member who is medicare and has the medicare advantage ppo plan. we refer to the families as split families because one is nonmedicare and one is. and we will have more information as well as potential low a recommendation to be discussed with the health service board at next mont's meeting president follausbee? >> thank you very much. >> i guess i expect i and many of the board members will be interested in that last point about the split nonmedicare and medicare families. whether the recommendation to move the nonmedicare to a uac how that will might affect any disruption in the current

primary care providers? who you know might be in the blue she said program but not uhc. that will be interested to see a summary of what this proposal would impact our members. president, we are under way in collecting data from blue shield and united health care analyzed for provider disruption match today. i have evaluated the financials. so what can tell you this is an administrative change consideration that will not impact the rates that are presented and hopeful low approved today. the cost basis for united health care to take on the members through their plans and networks is almost identical baseod my review toi nighted health care. the rates being improved would hold and this is an

administrative consideration that will possiblely present in the june board meeting. >> thank you very much. and so are there before we open upper there commissioner comments or questions. any other take arc ways from the big over view before we move in the specific rates and benefits agenda items? president follausbee. >> yes. >> after you. >> go ahead. age before beauty. [laughter]. president follausbee this is american scott. i wanted to raise a question i think i have asked mike on a couple of occasions during the course of this rating season. and that is the whole post pandemic equalization bump. are you getting further global impressions have you a reference under one of our plans about that. but are you getting anything

more from the field? yea. will we have been tracking you were experience and now we have some data coming in through april. certainly -- chief financial officer reportod what is observed through march. what we are seeing is some pressure on very high cost upon claimants from the pandemic possibility that individuals may have deferred cash or deferred care that would have informed on an early state of a condition that perhaps leading to more -- intensive care. at that stage. and so -- we are especially tracking some experience that come through 0 reasonable on one of the blue shield plans that will have miles an hour information on because it will fold in to chief financial officer report through april. in general, the information that we are seeing as we are looking

at year end 21 experience for clients and starting to get insights from 2022 is we saw pressure on cost early in 22 because of higher incidents of covid related in patient hospitalizations not in icu's the way they were happening in 20 and 21. there was a recent report -- coming occupant of the government and anticipating the possibility of higher covid activity and costs in the fall. so we will keep an eye on those developments i know president follausbee commentod the need for to yous stay diligent in his president's report. but at this point, we are not anticipating going in 2023 that we are going to see any spikes in plan equalization relative since mid 21.

our teams are following developments. they are confident in the trend rates are general low going to play out you know -- mindsful covid suppression but similar to prepandemic. >> thank you we look forward to that being true. we will continue to track it and if there are changes i will report back to you. >> thank you very much. >> and i have a question as well as commissioner zvanski. this is an administrative change with regard to split families, i thought i heard you say in terms of disruption it is almost negligent but is there disruption ball as you realize when something like this happens

people are look to providers most low. i'm not so worried about the major facilities like the hospitals in the immediate county but i am concerned about disruption and what are you finding between blue shield and uhc. >> sure, early, we are formulating the recommendation nothing is decided. what we find is that if you are an access plus today, you have ever a very strong provider match to translating to the united health care network. you know the broad -- epo concement. what i don't are trying to understands now is for those who are on the trio plan. what the relationship will issue like transitioning to a united health care you know i would say loosely trio equal.

that's where the conversations still lies with united health care. as we continue to work the data that will lead to any potential recommendation made of june. that is when we are focused in terms of you know potential to work through any disruption there are certain physician group and facility nas are in trio that are not in the united health care version network version that would be best comparable to trio. jowl will keep us updated. >> yes, we will have will full information and analysis when we again. assuming we make a recommendation in june that will being all fully disclosed. >> this impacts most low the early retirees. >> correct. >> 800 individuals.

the order. 800 out of 130,000. >> and the administrative effort to keep this in place is extraordinary. sets up for fail you're frequently we are looking to find a solution. to this situation so i think your questions are spot on reenforcing we are going down the right path we are asking the questions and -- hope to find a solution that works well for the individuals. and executive director having her report 500 access plus 300 in trio. that's the population size. and are these folks in my loved [inaudible]. they are not because they are not available in how much. >> that's what i nought i wanted to -- thank you very much.

>> and thank you. >> uh-huh. any other comments or questions? for -- hearing none opens up for public comment. thank you president follausbee. in person comment first then virtual. anyone in person you are welcomed to approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or

commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity. we'll begin with in person comment. no one approached the podium we move to web ex for virtual public comment. we have 5 callers. zero entered the queue. all callers dial star 3 now if you want to comment on this

item. we'll wait and close public comment for the item. public comment is closed. >> thank you very much. that closed item 10. and we will call for agenda item 11. >> thank you. president follausbee. item 11 review and approve blue shield of california flex fund the nonhmo plans rates and contributions. this will be presented by mike from [inaudible]. >> mike clark. this will be the first of our recommendation for approval documents on the blue shield of california flex funded nonmedicare hmo plans. you will see i will prosecute void a brief rate setting

preface i will cover in this document and it is in our other documents. we are once today. leading in the renewal summary. what we found for 2023 and leading to the rate cards for the active employees and early resooir tires and recommendation for action on the 2 plans today. there are appendix items i will not cover but for your reference including rate card footnotes, glossary and this year's rate cards. there are 3 types of funding methodologies. self, flex and fully insured. you see the different health plan and how they fall across the methods in this case, the blue shield access plus and trio plans in the flex funded category an insurance approach most of the claimed dlrdz are

based on services delivered but capitation as well. well is capitation in the blue shield plans and the health net canopy and other administrative fee and it is case of the blue shield plans only i large claim mechanism individual 1 million fer participate annualy. and so the under writing process on page 5 guess through a 5 step process you see on the page. resulting in a projection of 2023 plain costs for a plan. that i developed for the self funded plans for flex funded like the 2 presented here. i will work with the blue shield under writers to evaluate their cost prosecute jections and the under lying assumptions. the rate chink factor is a function of our projected costs

for 2023. divided by the 2022 rates times enroll am and this does include we will look on the next page not just thedivided by the 2022 enroll am and this does include we will look on the next page not just the adjustment and for these plan in march. >> and that leads to the rates you see on page 7. a reference point. to be able to see how the rates compare for active employees and early retirees total rates including all rate card elements. for each the health plans we will present today. >> and were reminder on how we segment tonight costs to employer contribution for active employees, there are a host of different strategies. that are in place. many negotiated through mou's.

the 2 most common for the city of san francisco employees who is the largest segment within the san francisco health service system. 93, 93, 83 defined the employer contribution amount. for each of the coverage tiers 93% from employee only. 93% from employee plus scombon 83 employee plus 2 or more employees paying the remainder of the defense or 196-83 come employees have that. i mention and the second not note, this will be important in item 13 for the ppo accolade well is a limiter on the contribution. to be set to the employ are contribution of the second highest cost plan the blue shield access plus hmo.

reminds that when we get to that discussion. early retirees based on city charter formulas the full contribution amount is based on 3 components. 10 county amount. approved in march. and the actual difference which is the difference in cost rate. between the retiree only and single tore and the employee only single tier and the prop e contribution which is a difference of what is left in the difference with cost rate and the employer contribution after considering the amount and the difference. you can see graphically in this chart how those figures very for each health plan. >> with this i will go into page 11. with the staff recommendation the health service board approved the blue shield access

plus removal for 0.5% rate increase in 23 for blue shield trio. 85.3 increase and the resulting rate cards presented in the material. and i will provide the back detail and coming slides that will be back to the recommendation of the conclusion of my presentation. on page 13 from a plan experience stand point. there are no plan design changes proposed for the blue shield hmo plans this is how plan experience forecasts in 2023. the commendation of access plus increase over all is 2.1% increase below trendses that are like in the 6% range. and you see all the various cost components included including

the medical and pharmacy claims capitation charges and administrative fees, the increase in the buy down from the rating surplus. the basic planned premiums approved last month and the same health care charge 3 dollars in place for several years. page 14 owner all plan experience. 9% from 21 to 22. both influenced by -- pandemic suppression in 2020. the plan 2022 rating reflected a typical plan equalization. after we adjusted for pandemic suppression in last year's experience. i know you will have a question.

the function of the large claim experience observed in trio relative to access plus in 2021. the nksz in the stablthization buy down is a benefit in the rating. the increases about zero.7% higher bout that change of adjustment and the aggregate 2.1 increase is low everybody than national average costs but higher than the rate increase that took place in 2022. knowing there were benefits from the rfp that played in the 2022 rating. the benefits sustained but have a reset denominator now into

2023. from fee stand point on page 15 in the second year of a 3 year fixed commitment from blue shield out of the rfp press for 23. large claim pooling fee is increasing by 12 penalty 5% after a 5% increase last year driven by high cost medications. influencing the experience for individuals over a million dollars. on page sfaevenl lead in the rate cards again the 2 -- formulas we show for the active employees and the early retirees driven by the city charter formulas. you will see on page 18 starting with what changes. you know -- in the bottom line on the employee and retiree contributions the top of the

chart active on the left. early retirees on the right. benefit to the active employees 0 opinion 5 increase guess all the way through for the early retirees the contributions decrease because the rate increase is 0.5% is low are than the 3 opinion 1 prz increase in the portion of the city charter contribution formula to the survey. that creates a reduction and the contributions they pay in 23 relative to 22 for the plans. and page 19, the early retiree side is the same. difference from the prior slide is this is 196/83 contribution. you seat modest impact due to the low increase for the plan. the rate cards for access plus

are shown on page 20 for the 93/83 employees on the left and early retirees on the right. early retirees the same on page 21 difference the actual employees on this page the 196/83. as we get in trio. it is the opposite impact on early retirees. 5.33% increase. now because of the county may or may not going up 3 penalty 1%. creates higher increases and i will say 33% is a high percentage, increase, it is 10 dollars a month relative to a total premium that is 2,000 a month. dollar wise it is modest increase because the starting

figure is low at 2917 it appear to be a large percentage increase. you see 496/83 the rate cards on page 24 and 25. with all the elements of costs. and that leads to page 27. to recommendation. first the healing upon board recommend the blue she said access plus plan renewal with 0.5% total rate increase trio plan renewal for 5.3% rate increase and the resulting 2023 month low rate cards as in the material for bath blue shield access plus and trio. president follausbee. >> thank you very much. you walk us 32 a complicated

slides and rate card and changes seem accessible. i appreciate that. i net that there is a convergence in total costs between the access plus and trio plans. due to the adverse experience in trio. but know the difference early on -- in the slides with total costs shrunks 115 dollars to 35 in terms of the total costs per month. i wonder where had is going in the future. highlights the personals of our own strategic planning. to include issues high cost pharmacy. since some of this is related to the pooling charges that gone up. part of the rate calculations it

is a lot of toed for thought here. i'm jimmie, comment botch that organism up. >> certainly. and i think you are right low point out the administrative de feos there is costs in both plan and they play out same for each of the 2 plans. the both the per employee per month and administrative fees and the pooling fees are the same. for the plans. so that is in the a difference in cost between the 2 ultimate low when rolls through are capitation costs. pharmacy costs and remining medical claim costs in patient and other things not associated with physicians. i agree with you president follausbee, we are seeing every year it seems trio increase higher percentage than access

plus and way its is a function of what has happened to transpire on large claims with the 2 plans but it is something we will discuss with blue shield and their care organization physician partners. >> an assume well is a mechanism to look at large claims to see if there were missed opportunities of care where care may have been offered you know early appointed the disease process rather than having you know -- people present -- with higher later the disease and may have higher costs. they are complex issues. open up to comments from commissioners. why this is commissioner scott.

as you talk about the medication feature a driver in this provider are we seeing that elsewhere across our plans. it is a general question. if so, can you give me the disease categories where we see this present? >> sure. these are very rare conscience so not something that is predominant it is more individual circumstances upon perhaps blue shield could speak to particular prescriptions they were seeing in high costs i will say examples include a drug that is now on the market that is typically a 7 figure cost called [inaudible] for treatment of rare spinal condition in infant. i will say and we talk about

this with the healing plan partners a way to get ahead of it is years ago there was not all that much emphasis by pharmaceutical organizations on research and development into drugs for rare conscience because there was not a large market share. when we have seen is a pivot starting 10 years ago or longer and now there is substantial effort to on the part of farm suit call organizations. all in the spirit of improving life and sustaining where perhaps in the past someone may not have been able to survive a given condition. but with that come a cost. so -- we are common law meeting with the health plans to understand how they are stayingly ahead in strategies. for patient management on

medications. executive direct do you have comment army from you were lens on our constant interaction with here, the acl physician partners? >> it it is a common discussion we have equalization of the expensive drugs and as well as you know -- there are many cases where we are living longer. and acquire conditions that are expensive to treat. and as well as have the conditions and rare diseases where there is new treatments and better pharmaceutical and biological the pipeline we were having this discussion yesterday with doctor joe from uhc who will touch on this upon during his presentation next month. we do in the strategic planning process, because of of the upon

it is an interesting costly reality. that we are facing now. and how what influence we have -- i'm afraid isingly. over the entire industry. with that being said. we doment to have a presentation on pharma. and are working withan and their consultant who is good to update the board on this but later in the year. and -- so we will do that and aulgsz on geneo mix. it is an on going conversation and the number of claims over a million dollars for each and everyone of our plans is growing all the time of and it is mind boggling to think we were important to at this point in our situation where we can we're able to afford it but how much, how long, how much big 30 gets it is quite it is a dilemma and

i don't know how small emloyalers are managing this. >> i look forward to the presentation. we had such a presentation 3-4 years ago. what was going on in that the pharmaceutical space and good to get an update from that stands point and rescue noise we are one employer. we have 120,000 lives. >> i will am caution us it is difficult for us to talk about the particulars of a case it makes it identifiable. we have a hipa situation so this detail woad not be speak publicly.

right. >> i will stress it is an example. not specific to us. [inaudible]. understands. thank you. interesting to note which -- interventions are short lived and, cute for immediate condition special which are the life of you know the member for the rest of their lives month evermonths, years or decades. i think than i are factors we look into. other questions or comments before i entertain a motion to approve the recommendations at this point? >> president follausbee this is chris canning i move that we approve the blue shield plan renewal for access plus trio and rate cards as presented. >> second. >> thank you very much.

>> moved and approved. and seconded we approve the rate cards and the blue shield plan and trio renewal proposals i open up for public comment. >> >> president follausbee. public comment. >> thank you. >> in person comment will be first then virtual anyone in person you can approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your

comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity. keep am upon begin with in person comment. i don't know approached the podium we will move to web ex for virtual public comment. we are 5 callers on the phone lineful wherevero entered the comment queue.

hearing no kaufrlts public comment is closed. >> thank you very much. move and seconded we approve the staff recommendations for the 2023 year for blue shield access plus plan and trio plan and 2023 monthly rate cards a roll call vote? thank you president follausbee, president follausbee. >> aye. >> vice president canning. why aye. >> commissioner breslin. where aye >> commissioner hao >> aye >> commissioner scott. >> aye. >> commissioner zvanski. >> aye. >> the vote is unanimous. >> before we call item 12 we

have been in session for an hour and a half we would like a 10 minute break. reconvene at 2:41. >> thank you, president follausbee.

agenda item 12. review and approve health net care medical rx flex funded nonhmo plan rates and contributions. similar format like on blue shield including a sum row of the renewal projections. and ultimate low the recommendation for board action with the same time of information as the prior

presentation. i will not go in detail the funds hid this is is i flex funding hmo plan similar on the blue shield hmo's we just presented. on page 7 the cost rates for the plan include a 10.4% reduction from the first year. at this time second year alcohol be 2023. s we move forward staff recommends the board approve the 23 care hmo plan rate card as presented. and which follow a 10.4 reduction in care hmo plan projected medical prescription and fee costs. with this reduction the rates in 2023 for healing net will be sloit low higher than the kaiser california rates we will present

later today and lower than the rates for blue shield of california trio plan a change from 2022. i will present commentary what is this and the rate cards for the 2 most common strategies for active employee is and the early retoire row rate cards which are reflecting emnotice are contributions boy form wells in the city charter. page 13. i don't have, lot of history to present on the health care plan for health net care because we are now sitting 4 and a half months in the start of the plan for us. i rely on projections delivered. by the healing net team. incorporating the medical and

pharmacy claims, capitation charges including most medical costs. administrative fees the commitments and the basic plan vision promotium and health care sustainability charge. well is in stablization in 2023 rates. nor was there in 2022, there will be for the 2024 plan year once we have full 2022 planned experience. >> communitiary behind the decrease. on page 14 provide per member per mont projections for medical claims. capitation and pharmacy rebates the 2023 plan year as part of renewal with the administrative de feos for medical and pharmacy components. in peculiar that is driving are the medical capitation rates for

forecast for 23. almost all over instinct % of costs in the plan to be les for 2023. it is nonmedicare plans press admit fall 2020. per health net the 22 medical capitation was set high. with actual demographic of canopy care. the cap tagsz rates are projected lower. while the projected claims include. our projected increase in the 2023 the reduction in the capitation rate off set this is and more leaving for the 10.4%

rate reduction in the 2023 plan year. and for the fee components medical administrative fees increasing 3% part of what was out lined over a 3 year process in the rfp and the pharmacy fees 2022 rates again a commitment from the rfp process. the figures you see on page 15 when we look at the 3 columns of information so the first is -- the projected per member per month information that was part of the rfp process again submitted in the fall of 20 between. the 2022 plan year and capitation being the largest component of the fees for professional and institutional and chiropractor services.

you compare nought 2, 2023 columns the 23rfp was their original forecast for 23 when developed for the rfp in fall of 2020. long before elections. long before knowing how00 autoelections would play out. 2023 renewal is the basis. and -- it includes the pmpm costs projected by health net and submitted in the renewal process a month. and while you see some increases in projected costs for pharmacy relatively to projected as well as an increase the fee for service claims the capitation

and prosecutejected to be lower for 2023 relative to had was forecast for 2023 during the time of the rfp. and so this is had leads to the 10.4% rate reduction forecast. ef you will see starting with the rate comparison on pages 18 and 19. for the early retirees and the active employees. page 18. sf increase of in the emplayer contribution driven by the city charter formula for the 10 county survey amounteen though

the employ are contribution decreases it decreases bia lower rate which means there will be wherevero contribution for retiree only for early retirees for the canopy care plan in 23. >> and so from 18 and 19 which were the comparison of change in the rates one year to the next the rate cards for care on page 20. early retirees and the 93 library 83 on page 21. for the early retirees 196-83 active employee formula. that takes me to my recommendation page 23. staff recommends the board approve the health care hmo plan rate cards presented. follow a 10.4% reduction in hmo plan medical, prescription and fee. president follausbee.

i will open up for discussion. i recognize with the rfp and experience is i gap. would additionalutization drive direction, ie more coming in the plan. there are not a lot of promotium chasers there are some who will say, my lord, this has gone down this year. we get an increase in enroll am and increase inutilization that would the outcome of the promotiums for the following year, correct? >>iel, commissioner scott i will story by answer and like to have

someone from health net on elaborate what he forecasting. we had a lot of discussion. what health net assessed they do expect an increase in enrollment and a demographic change. early on the demographics enrolled to date are first,able. expect to be a shift in demographic risk with added individuals and the plan. especially given the rate contribution zero. going in 2023. so as we had the conversation with the health net chief about the change special shift in capitation projection, there is a factoring in of demographic risk. i will pause hoping that the chief actuary from health net can identify himself and e

laberate under caution. >> good afternoon i'm greg the senior director for under writing at health net. like mike was out lining, we have low enrollment you saw that earlier today. so part of all of our forecast for 2023 it does take in account expanded enroll am in the plan and just for perspective our assumption is we grow by 1500 members in 2023 that is the assumption we work with. as part of our review, we look the at the population we had and then when we would expect for demographic mix for new members. and took in account our expectations about expandedutilization for the population that would enroll

relative to had we have. projections take into account some deterioration in performance relative to when we see now. the captated reimbursement discussions with canopy took in account that dynamic with expanded enroll am in 2023 and believe our cost prosecute jections are in alignment with that expected utile wragz for that growth. >> we did ask health net gifrn the large decrease if they would commit to an upper limit for haany increase could be then from 23 to 24 rates and health net agreed to that. and i don't know if you can speak to that as well. why we made the commitment that the over all cost projection for

2024 would not exceed 8% over the 23 projection. given the concern about the large drop in project cost proyekz and promotium and what might happen in 2024. >> thank you for that. >> you bet. thank you. president follausbee i like to follow up with that i think this is an interesting question. we have a way for own analytics to judge the severity of ill knows of enrollees in plans. and i'm assuming that you do as well. i'm curious, having made the assessment what the concern enroll am looks like and health status you know we like to think san francisco we are healthier than enrollees provide a healthier patient base demographically. is there evidence for that? or was this a surprise based on

the initial enrollment was a younger may be healthier population with fewure chronic conditions or risk factors? >> right. for us, when the rfp when we initially were proposing for san francisco, we have information about the whole plan performance. demographics and also claims history. our assess am from that information from the whole brood population was -- was -- a doofk mix 20% higher than what has enrolled in the canopy plan to date. there are a lot of things that influence that. a new plan. you have few members. people this may be were

incentivized to move and explore the hmo option in 2022. they fit that prosecute file. it is a favorable prosecute file currently. we would expect that to regress toward the moneys we gain enrollment. the population we are on now is -- good relative to the average measured by demographics >> thank you. yep. questions or comments. i will entertain a motion. >> president follausbee. commissioner scott, i move that we accept the staff recommendation and the rate cards as presented. >> second. >> moves and sectd that we accept the staff recommendation

and rate cards for the 23 healing net canopy care medical flex funded and nonmedicaid hmo. i will open for discussion? we will open for public comment. >> thank you, pot follausbee. in person comment first then virtual. in person you can approach the podium now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as

a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity. no one in person. we will move to web ex public comment. a reminder to callers you must

dial star 3 from you want to comment for this item. we'll wait and then close comment for this agenda item. public comment closed. >> thank you very much. now call for roll call on this motion. >> thank you president follausbee. president follausbee. >> aye. >> vice president canning. why aye. >> commissioner breslin. why aye. >> commissioner hao. >> aye. >> commissioner scott. >> aye >> commissioner zvanski. >> aye. >> the motion is unanimous. thank you very much we go to agenda item 13. thank you approximately not not item 13 rerue and approve blue shield medical rx flex fund

nonmedicare 23 rates and contributions. this is know action item and presented by mike clark. >> mike clark. this will be the ppo accolade. proposed 23 rates. looking at the agenda. we will review renewal sum row what is driving the changes in rates the monthly rate cards for both ppo aclay and accolade choice not available for active. and he was early retirees and you am see informing here i will not go through. from a rate setting preface the thingil point out in the introduction that this plan is self funded. which means that claimed dlrgz based on services are paid by the trust with the plan administrative fee and to manage the plan. so -- unlike the other plans we

are at honor using the determination on plan experience. and our determined cost trend assumptions and the administrative pos to prowse the rate recommendations you see today. >> looking ahead to page 11. staff recommends the healing service board proof the blue cheeld of california ppo plan and ppo plan choice nonavailable. montly rate cards presented and the resulting over all rate increase for the combination of the plans is 7.5% including stablization, adjust am i will upon explain. comment with rates is in document with an important reminder for active employees the mou for the employees specifies the contributions the

highest cost plan, which is this are equal to the employ are contributions for the second highest cost plan blue shield add sesz plus reviewed earlier. this guides how employer are contributions in the blue shield plan and rate cards for employee only tier, those employees pay no contribution for any plan including this plan. and the employ are contributions for the employee rate only for 196-83 are equal to the total cost rates. and a reminder, they are only 2 of many employ are strategics throughout all employers participating. and the early retiree rate cards in the full city contribution levels based on hire, length of service are on this rate card

presentation. page 14. for renewal sum row. we are recommending the increase based on 21 claim experience. trended 23. keeping in mind that the plan add administrator for 21 was united health care. for all individuals in the plan. now the plan add administrator is for most individuals in the plan is blue shield accolade. there are no plan design changes recommended. and you will see all of the different elements that feed in the rate cards you are about to see including a change from buy down in 2022 rating to buy up in 2023 rating. as rerowelled with the board, in left month's meeting the blue shield accolade plan was 18%

higher for covered life in 21 versus 20. again that is suppressed because of pandemic impact on claims for 2020. 2021 medical responsibles normalized to expected levels. prescription drug experience did in the exhibit suppression in 2020 a normalized increase expect trend increase of sick % on prescription drug. from 2020220 ton. and use the pp claim experience project the best mate for 2023 claim experience and factoring in the benefits from the rfp including changes in plan discounsels, rebate, administrative de feo in moving the add administrator for most members in the plans from united health care to blue shield, california the exception is for

nonmedicare split members. there is ppo plan availability for 400 covered lives remaining with united health care the plan add administrator. and the difference in the rate strablization be reserve amtorwragz a buy down for 2022 because of claim suppression that occur in the 2020. now going forward based on 2021 plan experience transitioned from a modest buy down for 2022 to a modest buy up for 2023. the combined affect is 1.5%. and reminder, blue shield committed to no increase in administrative fees for the first 3 years of the plan. 22-24. also wanted refresh on the

criteria for availability for choice not available. and who might be paying choice not available rates which are lower contributions for the member than the ppo plan. for active employees it is general low individuals and other geographies that don't have access to kaiser and blue shield plans. early retirees there are many who live outside of norman, california they would not have access to kiez and blue shield hmo. half of the early retiree base pace the choice unavailable rates individuals don't have access to hmo plans. and page 17. quick refresher on that, criteria rate determination and

how we do it to spruce choice unavailable pricing. the rate cards presented here again include active employees and early retirees. how the employ are contributions are determined for this plan the highest cost and estimates based on the mou. >> that leads for the ppo accolade. the change in rates and member contributions shown on page 20. for the active employees because the employer contribution is only increasing by 0 opinion 5% that was the rate increase for access plus; it does credit a higher percentage increase in dollar increase for the monthly employee and retiree contributions for the plan. and that's why you see general

low double digit increases for most of the tiers on this page on page 20. you know ranging from 9% to retire yee plus 2 or more to 22% for active employee and employee plus 1. and page 21, same figures for early retirees the 196-83 strategic for act itch employees. that leads to the ppo rate cards you see on page 2022. active employees and early retirees. page 23 for 196-83 active employees and early retirees. and transition from there to the choice not available, which again produces a strategic that creates lower contributions for the members. when than i did president have the choice of hmo plans based on

geography. and so because active employees the contributions follow the setting of contributions for access plus, the same 0.5% increase arc ploys. the early retirees lawyer to hawas for access plus there is a particular for the retiree only. and then a low are increase in the retiree contributions for early retirees versus the over all rate increases for the plans. >> and so on page 26 and 27. those pages illustrate the rate cards for ppo accolade choice not available. with that, i will conclude on page 29 with staff recommendation the board approve the blue shield accolade plan and the blue she said of california choice not available plan 23 montly rate cards

presented with the resulting aggregate rate increase the combination of the plans including adjustment for 2023 of 7 and a half %. >> president follausbee. >> thank you for walking us through a complicated scenario i open up to the board. commissioners for questions or comments? >> i move we approve blue shield of california ppo accolade self funded nonmedicare rate and contributions. >> second. >> moved and seconds. thank you very much. so you know any questions or comments from health service board members. hearing none. i see you hands hearing that we will open for public upon

comment. thank you, president follausbee in personnel first and virtual. in person you are welcome to approach now. each speaker allows 3 minutes. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

we have pie on the lineup. all callers you must dial star 3 if you want to join for the item. we will wait 5 more and close comment for the agenda item.

public comment is now close said. >> thank you very much. moved and seconded we will accept a staff recommendations regarding the blue she said of california ppo accolade plan and blue shield choice not rabble for the 23 plan year. including the rate cards. we will take a vote. >> thank you. role call. starting with president follausbee. why aye. >> vice president canning. why aye. >> commissioner breslin. why aye. >> commissioner hao. >> aye >> commissioner scott. >> aye. >> commissioner zvanski. >> aye. >> approved unanimously. thank you. you in move to item 47. >> , pruf kaiser california medical rx insured nonmedicare

plan rates and contributions. know action item and presented by mike clark. i will present the kaiser for the california geography. medical and prescription drug nonmedicare plan 23 rate and contributions. starting with a brief summary with this as a fully insured plan and the renewal sum row presents to kaiser. leading in the rate cards for 2023 recommended in filing the recommendation for action. there is detail in the appendix underwriting rate build up i will not go through that slide but happy to entertain questions on your rerowel. in the rate setting methodology process i will point to kaiser

it is a fully insured plan. unlike the other plans we talked about today. the kaiser rates are determined by the kaiser under writers. based on expectation. kaiser will remain the lowest cost rates of the health plans provided by hss to members.

looking ahead on page 11. revowing the recommendation i will come become to at the conclusion of the presentation. staff recommends the board approve a 3.88 premium increase for 22 to 23. active employees and early retirees in california and enrolled by the kaiser health plan. based on the full insured plan rates you will see in this material. and the resulting 2023 plan rate cards for the plan are included. in the presentation for active employees and early retirees. >> kiezir rates and premiums are include immediate this presentation and with detail reminder that active employee rate cards hone for the 2 most common contribution strategies in early retiree member contributions based on city

charter contribution formulas. >> on page 14. with status quo plan there are no changes in plan design. rates are proposed increase 3.88%. lower than the rate imagination that occurred for the 22 plan year. kaiser based rating development you will see in the rates from experience from february 21 to january of 22, which trended forward 23 months to match the 23 plan year. and -- this is a recollection we did rerue kaiser 21 plan experience at the board meeting last month. the 3.88% is kaiser best estimate for costs and well is know an exhibit. a question we like to look at

over all within the financials for the kaiser organization. and as released and reported by kiez and public earnings in february of 2022 for calendar year 21. there was growth in operating expenses. but exceeded by growth in revenues. or the operating expenses when we start that over the expense growth exceeded growth in ref you in from 21 to 22. you will see that in the table. revenues increased by 5 penalty 0% over all for the entirety. this is all kaiser coverage for all of their clients. expenses, grew by 6 opinion 9% in part due to pressures were covid-19. that brought to operating expenses in then operating

income increased but lower drr figure then and there in 2020. slide membership growth. we include the kaiser fully insured premium and basic. and the sustainability charge in the rate cards. as well as the components you see here for determining retiree contributions. so. go ahead to page 19. to show what rate change is playing out in terms of projected change in member contributions. you see that in the top of page 19 for active employees contribution strategic, as well as the early retirees for early retirees and only tier, contributions will remain zero

they have in prior years. for that tier. the 3.9% increase matched the 3.1 in the amount and as a result the increase cascades through member contribution increases, employer contribution increases and total rates. of and so far you see that for the within nic-83 strategic for active employees on page 20 that leads to the rate cards we start with insured planned premium the premium row is proposed by california for 23. for active employees and retirees with the vision rates and 3 dollar sustain ability charge special formeramies playing through the rate card. you will see the rate card page 21 and 22. for the 93-93-83 and 196-83

active employee and early retirees. that leads to page 24, staff recommends the board approve a 3.88% premium from 22 to 23 for the active employee and early retiree in california in kaiser hmo based on the plan rates prosecute posesed by kaiser for the rate cards the kaiser hmo plan for active employees and retirees, president follausbee. >> thank you very much. >> a question, you mentioned the increase in operating costs. for kaiser. because related in the last year related covid was this the articles now in the -- various media regarding across the count row medical center costs going up and they attributed to

staffing issue around nursing and having to hire traveling nurses. do you know break down in terms of the rise in costs with kaiser and due to covid in 2020-21. >> i know this there was a recent release of quarter one 2022 earnings. i would ask a representative in the room for kaiser to address your question. president, follausbee. >> good afternoon denose with kaiser. president follausbee would you restate your question? i'm -- articles in the national press regarding the increase in operating cost and medical

centers during the 21 covid pandemic. and attributed to staffing issues regarding difficulty staffing nurse. within the centers and also other health professionals. since we heard that the operators costs went up related covid is it related to staffing issues? there are several components i can point for to you today a higher care volume caused by covid the deferred care there was a backlog. health care labor shortage you are speaking to leading to increased labor costs that is a national issue i have a niece who is a traveling nurse and she is all over. higher covid costs and testing expenses this on going.

there has been supply chain disruptions because of labor shortages in supply chain. external provider charges when we send the members out. drug cost escalations we heard about that earlier today. and then new regular requirements you can't open the newspaper without now requirements for all the healing plans now. those other key drivers for our increase in operating expenses. >> thank you very much. >> i may ask a follow up you issue looking forward are any that will be carryovers to -- the next rating cycle? i assume staffing that will be a problem. doe see a decrease in the supply

chain issues? it is hard it say now. i can tell when you we look at the 2023 renewal cycle we finalized our renewal process and seeing a 1% increase in average rate increase year over year. you know we don't know if there will be another surge. oui are hearing rumors there will be something in fault. so you know i would be guessing. i think that the point i would like to leave you with kaiser learned a lot. we opened up new will bes. opened a lot of clinics. partnered with cities and counties like san francisco. i think we will number a better place but don't know what the vol automatic look like. that's the unknown. >> thank you very much. >> sure. anything else. >> thank you. other questions or comments?

president follausbee i will move if you are red for a motion move that we accept the staff recommendation and the related rate cards for kaiser. >> second. >> [inaudible]. >> second. >> thank you. moved and seconded we will accept the staff recommendations regarding the premium increase for active. and he was early retirees in the california kaiser per minute nenlty fully insured planned rates for the 23 year and rate cards. further discussion? open up for public upon comment. >> thank you, president follausbee. in person comment will be first and virtual. anyone wit nothing person you are welcome to approach now.

comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

we will begin with in person public comment. no one approached we will move to webeck for virtual public comment. we have 5 call are on the line. zero in the queue. all cullers on the line you must dial star 3 now if you want to join comment for this item. we will wait 5 seconds and close public comment for this item. >> no call are, public comment is now closed. >> thank you very much. >> moved and seconded. we accept the staff recommendations for 3.8% increase in plan premium for

2023 for active and early retirees in the kaiser healing plan and the rate cards. a vote? >> president follausbee. >> aye. >> vice president canning. >> aye. >> commissioner breslin. why aye. >> commissioner hao. >> aye >> commissioner scott. >> aye >> commissioner zvanski. >> aye. >> remark approved. thank you very much now agenda item 15. >> thank you. agenda 15 rerowel and, prove active employee dental rates for delta dental ppo plan. usa hmo and united health care hmo. this is an action item and presented by mike clark. >> mike clark.

my final presentation the recommendations for active employee dental plan rates for 2023 plan year. for the self funded plan listed. the active employee ppo and 2 fully insured plans dela care and united health care. and just as a reference point there are active employee denialal plans in the appendix for reference. as i mentioned there is a combination of plans presented. action for recommendation. on page 7, renewal sum row as just a reminder we presented the

retiree dental plan rate renewals last month in the april board meeting and so today we are focus on the active employee plans. >> page 8 another set up reminders about the plans the act ever employees within the city and county of san francisco court and municipal executives association employees are offered the dent the coverage for active employees. there are fixed month low contributions. based on mou strategics for the employees of the organizations you see in the first subbullet. pay 5 a month for the employee only tier of delta dental ppo. 10 dlrsz and 15 for employee 2 or more for the active employee ppo plan.

no contributions required for employees electing the 2 hmo plan and superior court and mea employees pay no contributions for any plan. the san francisco school district and city college employees don't elect to offer dental coverage. active employees throughout the city. from a total rate change stand point. the information on the table on page 9. there is a large increase in the active employee dental plan rates. which directly follows i large decrease for 2022. driven by the large claim suppression in 2020 because of the pandemic. and then the rate stable wragz adjustment made for 22 rates relative to what had been done

in the past we'll review that. the proposed ppo rate change includes a plan enhance am we'll discuss later. you see no changes recommended in the rates for delta care usa and uhc dental they will forecast to stay the same as in 23. you see by the enroll am coming from the demographic report the vast majority of employees do so in ppo plan. most of the total rate increase is attribute believe to the rate stablization adjust am. i will rerowel on the next page well is a portion related to -- a recommended design hen enhumansment to not apply to the over all annual plan mack a way to improve rate preventive care

by the population in the ppo plan. the plan experience is -- favorable. when you we do that under writing basis compared to when we forecast plan experienced to being in our 2022 plan under writing. mou i would not celebrate this it imploys that planutilization is lower. our people getting back to seeing the dentist we want to encourage members to seek cleanings. the rate stablization. i will go to the next page to illustrate the history of rate stablization and why there is a rate next recommendation for this year in the context of what happened last year. so -- the plan had built up

since first offered in 2014 on a self funded basis has builtum stablization reserves over time. it has never been in deficit and starting with 2020 plan year, in order to start to more keenly spend down the accumulated rate stablization amount in the lower right. we recommended the service board approved using a half of stablization reserve for the 2020 plan year that was approved in spring 2019 and 21 year approved in spring 2020 as the pandemic started. we started to realize the impact of the pandemic on plan costs you see because of the large amount suppression how much the rate stablization built up in 19

and 11 million to december 31st 2020 at over 18 million. so. the decision was made and approved in the upon 22 rates to fully apply more intently all of that claim suppression that built up in 2020. so there was a 14 penalty 4% rate reduction from 21 to 22. because of how much and that's what i highlight for the 22 plan year. 12 million plus applied in 22 rates. now we are back and they approved using 5.3 million for 23 which is similar to what happened in 21. and so when we look at the rates

that were recommending for 23 total cost they are comparable and a little less atlanta the 21 cost rates. i want to put in context that when you look at 15% you think, that is happening with plan experience in it is all because of how we used the mechanism last year to -- basically spend down a higher rate all of that claim suppression relative to forecast for 20 -- that occurred because of the pandemic suppression. i think the next page illustrated well what happened to the bottom line claim experience. taking stablization out for a mobile home. you know when we look at that the claim and expense has been, which are the solid bars on page 16, i don't think the page is

showing. relative to the projected premium per employee per month you see in the line, there is where you see in 2020. you know after years of loss ratios that were in the mid-90's to 100% a suppression for 2020 we used that difference to apply a higher stablization amount for 2022, and now we are back to more typical forecast. become to where we were when we looked at plan experience for 2019 to forecast the 21 rates. the what tell lead to the recommendations you see on page 13 is there is a large increase in the rate, you know the rates are what we forecast for 2023. to what they were developed for

2021, long before we knew hat suppression impacts of the pandemic would be. a look to page 15. will you know the again the change incorporates the 2021 claim responsibles. and also incorporates the projected claim impact 1 penalty 17 million from a design change to ecclude like it does in the retiree plan the accumulation the claim costs for preventive services. we want to remove the public financial barrier claiming an x-ray service with those costs no long are applying to the max. and for context, you know 9% of memberers achieving the maximum 5% in 21 or came close within

5004% in 2021. we are reflecting buy down. stablization approved by the board in march. add administrative fee we are in the second year of a 2 year rate agreement with delta dental the fee will remain the same has it has since 2019 that is on page 16. the prosecuteject the rates the cost rate contribution of enroll am over 30,000 employees and how they distribute across the tiers. what the 23 prestablization rates would be without the design adjustment what they are then with the design adjustment recommended today. how that translates by the buy down. and to the recommended rates for 2023. that you see toward the bottom

of page 17. and then for briefly, reviewing the hmo's again no change in rates for dealt care part of a second i don't remember. to maintain rates for 23. and united health care forecasting no change in rates it is an annual renewal. you see on page 20 what they are in 2023 they will be the same as in 22 with no employee contributions for the plans. with that i will go to page 22. today's recommendations are the staff recommends the board approval of the following 23 active employee dental plan rate and administrative fees information provided boy me in the presentation. for the delta dental pp apolo anton ohno change and 15.3%

increase and cost rates from 22 to 23 which includes design change to exclude costs from preventive services to members 2500 benefit max the delta care usa fully insured plan no change in insured rates for 22 to 23. and united health care dental plan no change from 22 to 23. president follausbee. >> thank you very much. >> and thank you for continuing to put the perspective of prior health service board decisions in the complicated calculations around the ppo plan. with that open for questions and comments from board members. >> i have a question. do you know the mechanics this received the diagnostic and

preventive. we included that in the march presentation i believe it is 2 thirds of members. which is lower than it was prepandemic. received a diagnostic preventive service in 21. >> and did you say 5% member achieve the mack. >> 85% don't >> 95% don't, chief the max. >> does in the seem like that is the barrier to get them diagnostic care to me. again i say it is education. and delta dental getting an increase of 2 penalty -- anybody from delta bental here.

>> claim increase estimate. may or may not happen. it ultimate low will play out in terms of the kwhat actual cost increase will be and how members utilize the plan. 2.sick % is the best mate. but the actual claim experience potential to vary from that estimate given this it is a self funded plan. i will ask a representative of delta dental to speak to your question as well. >> good afternoon commissioners. is your question in regards to the active employees? >> yes. jot question is what do you do to educate you send blast e mails or flyers saying -- you know you only sought dentist once this year. or -- say -- point out all the

things that can help if you don't see your dentist. would be nice if they could point out what you retire tell cost a fortune and when you are active take care of your teeth you will have a problem. >> sure. >> a lot don't realize that. but -- they don't pay attention. i think it is -- united health care get notices. you did not do all this and this is something delta should be doing if you are not doing it. >> sure. absolutely. and in to address the marketing we have a variety of ways we market. we can do e mail, mailing as well. and we also have wellness initiatives such as a mnthly wellness cal dear we offer with different remindsers for example

may mental health month there are different initialives. there is a variety of marking campaigns we can initiate. i riverly see anything from you regarding delta dental. you believe are autoenroll in the the program this allows 2

additional cleanings and different initiatives. they are in the getting i basic cleaning. that is my point. and you sends blast e mails to initiate it we need e mail address. it is one. you have their home address sends out manage in writing. like [inaudible]. sure. >> that's i think that u noticed health care should be doing that. definitely. i would like to see health services follow up. we have an arrange am we are puffing dignity quarterly reports, we skip it during rate and benefits we are busy.

we can add that to the reports we do and what the campaigns can be. i think jessica communication director in thing they will coordinate activities. >> absolutely. thank you. i wonder if delta dental locked at surveyingly membership whop have coverage to finds out the barrier. is it location of dentives. is it scheduling? is it [inaudible].

we had a motiving with marketing and research team 6 mobs ago and we will follow up on that as well. why thank you. >> okay. other questions or comments? i like to make comment it was my dentist's office that called me and said it is time for another cleaning or a checkup and i found it was the dentist this did the reminders. delta dental. >> i'm surprise said. your dentive has your information. >> a lot of people don't have a regular dentist no one will out reach. i have through another delta plan a dentist and i get out reach all the time i have i regular dentist a lot don't. i suspect the lack of people who never identified a dentsist as a regular dentist.

>> good point. if it is i would like to offer a motion. >> thank you. i move we sept staff recommendation and the rate cards as presented. >> second. >> delta dental. >> thank you very much. it has been moved and seconded that we accept the dental delta acist employee ppo cost increase and rate cards. with no change in the insured rates for delta dental hmo plan or united health care delta hmo plan. open for public no further comment from commissioners i open for public comment. >> i have a comment in the wreel to spin down the surplus from last year we are now experiencing sticker shock. i understand it is relative to

the spend down of the reserves. 15.3 has a psychological affect. >> i agree and -- we had careful consideration of that during this time last year. did reference during the rate approval of the discussion for the active ppo plan last year this was the likely impact i like to see it as like a 3 year progression from typical rate, low rate and back to typical rate i understand. no question. open up for public comment. >> thank you. in person comment will issue first and then virtual. anyone in personure welcome to approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then #

1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak. 5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity.

we will begin with in person comment. and no one approached we will move to ebb western district of texas for virtual public comment. keep have 4 on the phone line zero in the queue. all callers you must dial star 3 now if you want to comment on this item. we will wait 5 seconds then close public ment for this agenda item. >> hearing no call are. public comment is closed. thank you very much. moved and seconded we accept the staff recommendations. for the delta dental employee ppo plans with rate cards and no change in the hmo or united

health care insured dent at hmo plan a row? president follausbee. >> aye. >> vice president canning. >> aye. >> commissioner breslin. >> aye. >> commissioner hao. >> aye. why commissioner scott. >> aye. >> commissioner zvanski. >> aye. >> passes unanimously and glad we are here and voting. thank you very much. [laughter]. thank you for your patience with the numbers today. i appreciate it. >> thank you. why thank you. >> and mike i want to thank you for your presentations i think proceeded clearly as complicated calculation and methodology i appreciate that. as well. >> thank you. >> so that closes the rate and benefits section of our agenda.

now call for agenda item 16. >> thank you. reports and updates from helling plan representatives a discussion item and any plan representatives with approach the podium.representatives a di item and any plan representatives with approach the podium. good even area vice president for blue shield of california. today i'm taking a new role at blue shield of california. i'd like to introduce my successor in this role, amy deheart. and i would like to let her introduce herself. before that i want it say that this is has been a wonderful 9 year journey i have been working with this board and staff for 9 years. and reflecting back, you have pushed us to be a better healing

plan. we have done some what i consider, mazing work together. we have 100 initial account customers and i can say that nobody pushes uss hard as you do going back 9 years to develop the aco's was the strart of my introduction. we provided benefits that were not available. and most reasonable in the left 2 years pushing blue shield to do meaningful work around health equity. it hen an honor and pleasure to work with executive director and her staff and this board. thank you and introduce amy deheart. why thank you, amy dehart i'm the new area vice president of

arc counsel in northern california. i robbery with blue shield for 20 years i'm not now to the work. and i'm excited work with sfhsf and live add to the legacy that paul and the team created. very much looking forward to you all as we serve city and county of san francisco employees. >> welcome. >> thank you very much. will i have one thing the team that works with staff tiffany chung and adam will remain on -- working with you. well is a let of consistency on the team. that will continue. >> thank you. good afternoon commissioners michelle with delta dental i like the opportunity to

introduce julie fer new englanda your new delta dental account manager. previous has left the organization so it is with great pleasure i introduce julie. hi. i'm julie account manager of dealt dental i have been with them for 15 years and excited work with y'all and support your initiatives and appreciate the opportunity. >> welcome. >> thank you. thank you very much as well. hello good afternoon i'm tim closzen i'm with health net of california we are here to introduce ourselves for the first time in person we robbery working with you for about 2 years when the city was made it offer canopy care in health net and our pleasure to work with the staff and aband he her team

and all of the representatives that take care of your membership. we know we got a unique and exciting arrange am with canopy care and appreciate all of the support and guidance we have been get and want to look to continue to serve the members in san francisco and your account and condition our mission to improve the health of the community. we serve from the commercial market, which is large groups like yourself to california to medicare and medical. we look at ourselves in the community and look forward to the relationship. thank you. >> hello commissioners i'm fred reyes i'm the newark pointed account manager for the san francisco healing systems and it is a pleasure, obviously i want to echo what blue cross said pushing carrier to the limit and

demanding more that always carries guess beyond not only pltdz account but customers look forward to serving the system and the board. >> welcome. jim? politic follausbee there ask no one else that propped the podium y. thank you very much. open for public comment. thank you president follausbee in personnel extent first then virtual public comment. for anyone in person you are welcome to approach now. comment opportunity. providing public comment: dial 415-655-0001 and then enter access code 2496 295 9285 then # 1. press # again to enter the meeting as an attendee 2. you will hear a beep when you join the meeting as a participant. a. stop and listen b. wait for public comment to be announced. 3. when public comment is called, dial * then 3 to be added to the speaker line. 4. you will then hear “you have raised your hand to ask a question, please wait to speak until the host calls on you.” callers will hear silence when waiting for their turn to speak.

5. to withdraw your question, press * then 3. - you will hear: “you have lowered your hand.” 6. when the system message says “your line has been unmuted” - this is your time to speak. 7. when the president or commission secretary states “welcome caller,” you are encouraged to state your name clearly. as soon as you speak, you will have 3 minutes to provide your comments. 8. once your 3 minutes have expired, you will be moved out of the speaker line and back as a participant in the meeting. you will hear “your line has been muted.” 9. participants who wish to speak on other public comment periods can stay on the meeting line and listen for the next public comment opportunity. we'll begin with in person comments. we will move to web ex for virtual comment. >> we have 4 callers on the

phone line zero in the queue. all callers dial star 3 now if you want to join for this item. we will wait 5 seconds then close for the item. no further callers. public comment is now closed. >> thank you very much this closes item 16 and pleased to, nouns 17 is adjournment. if there is no business we will adjourn the regular motesing of health service board of san francisco may 12, 2022, thank you very much.

>> when i look at an old neon

sign that's working or not working, i feel the family business that was in there. >> since 2009, citywide, sf shines, has supported businesses and sites like the ones that receive new neon signs. >> you know, sf shines is doing an amazing job to bring back the lighting and the neon glow of san francisco. >> sf shines is such an amazing program, and i can't think of another program in another city that gives matching gunned funds to store owners, mom and pop owners, and if they've got a neon sign, they've really got a great way to advertise their

business. >> this is a continuation of the sf shines program. >> focusing other neon signs is relatively new to us. of the seven neon signs, we've invested about $145,000. >> a good quality sign costs more, but it lasts infinitily longer. as opposed to lasting five years, a good neon sign will last 15 to 20 years. >> in san francisco, the majority of neon signs are for mom-and-pop businesses. in order to be able to restore these signs, i think it gives back to your community. >> part of the project has to do with prioritizing certain signs in the neighborhood based on their aesthetics, based on their current signs, and base

on the history. in the time that we've been here, we've seen a number of signs restored just on eddy street. >> there are a number of signs in the tenderloin and many more that are waiting or wanting to be restored. i have worked with randall and al, and we've mapped out every single one of them and rated them as to how much work they would need to get restored. that information is passed onto sf shines, and they are going to rank it. so if they have x budget for a year, they can say all right, we're going to pick these five, and they're putting together clusters, so they build on top of what's already there. >> a cluster of neon signs is sort of, i guess, like a cluster of grapes. when you see them on a corner or on a block, it lights up the neighborhood and creates an ambient glow. if you havy got two of three of them, you've created an

atmosphere that's almost like a movie set. >> some of the hotel, we've already invested in to get those neon signs for people to enjoy at night include the elk hotel, jefferson hotel, the verona, not to mention some we've done in chinatown, as well as the city's portal neighborhood. >> we got the fund to restore it. it took five months, and the biggest challenge was it was completely infested with pigeons. once we got it clean, it came out beautiful. >> neon signs are often equated with film noir, and the noir genre as seen through the hollywood lens basically depicted despair and concentration. >> you would go downtown and

see the most recent humphrey bogart film filled with neon in the background. and you'd see that on market street, and as market street got seedier and seedier and fewer people continued to go down, that was what happened to all the neon strips of light. >> the film nori might start with the light filled with neon signs, and end with a scene with a single neon sign blinking and missing a few letters. >> one of my favorite scenes, orson welles is chasing

rita hayworth with neon signs in the background. >> i think what the office of economic and workforce development is very excited with is that we'll be able to see more neon signs in a concentrated way lit up at night for visitors and most especially residents. the first coin laundry, the elm hotel, the western hotel are ones that we want to focus on in the year ahead. >> neon signs are so iconic to certain neighborhoods like the hara, like the nightcap. we want to save as many historic and legacy neon signs in san francisco, and so do they. we bring the expertise, and they bring the means to actually get the job done. >> people in tenderloin get really excited as they see the signs relit. as you're driving through the

tenderloin or the city, it pretty much tells you something exciting is happening here. >> knee an was created to make the night more friendly and advertise businesses. it's a great way of supporting and helping local businesses. >> there's so many ways to improve public safety. the standard way is having more eyes on the street, but there's other culturally significant ways to do that, and one those ways is lighting up the streets. but what better way and special way to do that is by having old, historic neon signs lighting up our streets at night and casting away our shadows. >> when i see things coming back to life, it's like remembering how things were. it's remembering the hotel or the market that went to work seven days a week to raise their money or to provide a service, and it just -- it just -- it just

>> good morning everyone. i am the c.e.o. of a housing and community development organization serving the entire city of san francisco. really prioritizing children and families for the future of our success. what an honor