like to call the health service board june 8, 2023 to order. rise and recite pledge. [pledge of allegiance] >> now have a roll call -- >> agenda item 2 roll call. starting with president scott. >> present. >> vice president hao yooch present. >> commissioner breslin. >> present. why commissioner canning. >> present. >> supervisor dorsey. >> present.

commissioner zvanski and follansbee will arequire shortly. >> thank you, now to item 3. agenda item 3 general public comment. opportunity for the members of public to comment on matters in the jurisdiction not on the agenda. and including requesting a board place it on a future agenda itemful >> we will post our full instructions and i will read those aloud. >> public comment is now open. there will be an opportunity for general public comment at the beginning of the meeting and an opportunity to comment on each agenda item inform person comment first and then remote. for anyone wait nothing person approach the podium now. each allowed 3 minutes unless the president deems new time limits. all comments made concerning item that hen presented. call are may ask questions but

no believe hear up to 30 minutes of remote public comment for each item. members of public via phone call in by dialing 415-554-0001, acccess code: 2592 851 6797 ##. and press pound. enter the web near password. 1145 and then poundful star 3 to be added to the queue xu will heart prompt, you will hear your name to ask a question. when the system saysure line has been unmuted you can speak. for those watching on web ex click on the raisad hand icon. it will appear next to your name when in the system a request to unmute will appear on the screen. select unmute to speak. when you hear, welcome, caller

you can speak. when your time is expired you will be muted click on raise's hand i conto lower your hand. thank you sfgovtv for sharing the meeting with the public. move to in person public comment? and this is for items that are not on the agenda. for this meeting but may be subject to a future meeting. please. benefits -- i wanted welcome supervisor dorsey good addition to an already good healing service commission. so, that's what i wanted say, welcome >> thank you >> thank you

>> thank you. >> no one else approached we will move to virtual commentful we are one caller on the line zero in the queue. there are no callers at this time >> thank you. we have one written comment that came in i will summarize that. this was from steven nesz, muni retiree worked for the city for over 30 years expressing he was happy with the dental coverage

through delta while working but in retirement the plan was disapointing and not worth having. the limit on the service covered went up and does not cover much especially in live inflation. expressed appreciation for the work don give at this time good health plans but hoping the board will improve dental coverage in the future. >> we will thank the retiree for comment. thank you. >> with that, public comment is closed. >> thank you. we'll move to item 4. >> agenda item 4 accident approval with modifications of minutes of the meeting below, may 11, 2023 healing service board roll meeting minutes. >> thank you. there were edits provided by commissioner follansbee and have they been incorporated to the

minutes we have? so, are there comments or edits from the members of the board? photocopy not i'm willing to entertain a motion regarding the minutes of the may 11 meeting. so moved. >> properly moved. is well a second? >> seconded. >> the minutes of may 112023 health service board regular meeting be approved. are there comments from the board? go to public comment. >> thank you, president scott. we will share instructions online. public comment is open. instructions are on the screen for those on sfgovtv and web ex.

we'll begin with in person public comment. no one approached. we'll move to remote public comment. we have one call or the phone line zero in the queue. there are no callers in the public comment queue. public comments is now closed. >> thank you. we will now take item 5.

>> should we take a vote? i'm sorry. i'm trying to get ahead of myself. roll call vote on the minutes. >> roll call starting with president scott. >> aye >> vice president hao. >> aye. >> commissioner breslin. >> aye >> commissioner canning. >> aye >> supervisor dorsey. >> aye. >> and commissioner follansbee and zvanski not voting yet. >> i'm going to claimant privilege of the chair we have item number 6 the laefktz health service board officers vice president and president. as item 6 on the agenda. our chair for the governor committee is on route when he arrives we will take that up at that time. we will be out of sequence. next item will be 5. president's report. >> agenda item 5 president's report this is a discussion item

presented by president scott. on the special meeting on the 25th of may i made remarks regarding the current health care environment we are in. and -- how that imfacts the decisionmaking of this board in terms behalf it can and can't do. i would refer anyone back to the may 25th meeting regarding those remarks. what i would like to under score a couple points today. because they are pertinent as they were when considering acting on items regarding active employee rates and early retiree rates at the last meeting. i highlighted there were 3 large do maintenance of activity we can engage inform cost shifting. operational and administrative

efficiency. and optimizing the provider network for costs and quality. those same domains apply as we consider retiree rates as well. and when we begin to talk about those things there are obvious features that stand out when we talk about cost shifting. everyone understands they share an employee or retiree pay and the city pace. i highlighted we could have income based krksz as a consideration. that would take policy changes and a lot of effort on the part of the staff as well as getting agreement with our labor unions and so forth to make those changes. we also can begin to talk about in terms of cost shifting, plan design. we looked at the plan design

changeings last time and declined to accept it. and we have looked at plan design issues as we look at the action items pending today. this board will probably need to do an educational session so that we can understand kinds of what are the mixture. what are the issues? what are the possible cost saving opportunity. if we engage in the large plan design change, would result in lower prepare yums for both the city and coincident as well as employees. again, that is something that needs a bit of a run way and discussion to engage in. so. i would expect that possibly at our august meeting or september meeting we are going to have an educational session for the board and by since we dot things

in public, tell be for the public as well so that we all can understand what we mean by the issue or the concept of planned design changes. what features, what issues, what do health plans typically do, how are these taken in account? and what components do you take into account in making planned design decision? developing a common lexicon or dictionary about what we mean by plan design changes, should be an educational opportunity for the board in the next few months and by the board i'm saying the general public interested in our proceedings. >> wee also know what looking at administrative and operational areas, one of the issues i raised last week and again is we could be talking about e

eliminating a plan and that creates all kinds of employee and retiree disruption when you make plan provider changes. for it going out and competitively bidding for various plans to cover various employees and retiree populations segments. this takes a great deal effort on the part of the staff and this board to engage in that process. the result of which we will see today as we look at our act rarely. we retiree plans years ago and decided wield not make plan shifts after we looked at the market. even taking that informational look a lot of work and effort by the board.

lastly a large area of effort could be optimizing met works combining and getting in large are purchasing groups or -- working with partners saying this is when we need or inspect design or plan other benefits or what have you. will not immediately impact rates you see this day or year. normally the, we implement for

the next or the even the planned year beyond that. so -- i ask you to consider those things as you make comments about when we are seeing. in terms of premium increases. not only for retirees and active employees as well. we as a board tried to go through the process, working with our actaries the results are had you see today. aband he leadership and management team have been i would say merslessly called before the powerhouse it be at the city how we save on this and that. act we have been tried to be support of the team as they engage in the the processes

resulted in the action items presented. we are here were today. we are going to try to be sensitive as possible to public comment. and input. ideas, suggestions that may come to our attention in the days ahead. but again, we just can't individual leaved mark our own way in this process. it has to be done leveraging the partnerships of others. with that, that is my president's report of the >> thank you for listening. >> next we'll take up item 7. the director's report. >> public comment on my comment. i don't want to hear the public comment on my comment. go ahead. public comment. >> thank you, president scott. >> instructions will be on the upon screen. actuary actuarial

there are no caller in the public comment queue at this time. >> thank you, hearing no

callers issue public comment is closed >> thank you. we will take up item 7. the director's report. >> agenda item 7, director's report this is a discussion item and presented by abbie yant executive director. >> good afternoon, be abbie yant executive director. i'd like to invite jeff forward, please. he brought his family. cool. who he talks about often and 55 to the in his decision to retire >> there is a bit written but in the director's report and i will sum it up saying 31 and a half years, congratulations! >> thank you. you bounced upon around the city.

kind of keeping it going. and for that we all appreciate i know i have enjoyed work with youing the last couple of years where we have done things to keep you in the forefront and there for everybody during the pandemic. so, thank you. >> you are welcome. giment to read to you what is forth coming in a proclamation from the mayor and eye in the s london breed not me. okay. where as, on behalf the city of san francisco i recognize and honor jeffrey lmftce ap with the san francisco health service simples throughout your 31 years of service to the city of san francisco, city college,uneified school district and the city courts. you have shown dedication and passion to service employees, managers and leaders and departments, seek mental health support and organizational

service. your institutional knowledge and tireless commitment to serving employee in need impacted many lives. earningut respect of your peers. your years of service contributed to the san francisco city family. and is truly commendable. best woishs a well earn exclude deserved retirement. >> thank you. >> all right! [laughter]. very nice. [applause]. thank you. if you don't mind board being thank you for the acknowledgment. i appreciate t. i had a simple goal as councillor, and that has been to try to make the lives organizational lives personal, lives of the employees that i

interacted with if i can make it a little better i have accomplished my goal. i do believe that we are all in this together. and i do believe in taking care of our own. and yes, the e ap lived many lives. here in dph and dhr now healing service system i continuing is the proper home. lucky for us we have a director abwhoa really passionate about the physical and upon mental well being of employees and retirees, soon to be me. which is nice to z. our manager kerry, could not be better. you know i will have to say that janet and i hear stories across the city system managers not so good. and she and i thank god that we have kerry as a manager. >> so. very much appreciative. also -- my coworker janet focusd

and willing and able to move the e ap forward in directions i think will be useful. i think that the e ap is in good hands. thank you gwen for the acknowledgment. i appreciate it and your work the board's work is appreciated as well. thank you for your service to the city and to us and the employees and members. . welcome to your family as well.

>> so, the rest my director's report -- what i want to highlight, reminder i believe will be done today on the ending the blackout notice. continue to the board. never mindful okay and then i -- was reasonable -- urged to join the health the state health care affordability committee as i accepted my -- application to be a member one thing i'm not sure and it is good or not. anyway. no tell be good this health care add rise real board is appointed

by the governor has a monumental charge to put in place some controls on the health care pend and the state california. and this has been dmn 7 other states. and to various degrees of success we'll see how far we can go in california. and it is a noble cause and i will keep i posted as things move forward and connect you with the website and keep everyone informed to what is progress with in group. the health ecquit diversity updates is pride mont. and we are in our second year of celebrating as a city holiday juneteenth, which we had to get used to it our budget cal dares it was on a tuesday that bumps the board of supervisors by a meek. so -- there are good will to

celebrate with our various populations. also good news and on the personnel front. i know riand of ga are here and they are delighted that we have very active recruitment. i had not seen offer letters to sign today but hopefully today or tomorrow will sign offer letters and filling some cold seats that will turn to hot seats fast. we do have a demand of calls that our members are frustrated we are, they can't getllow. so -- we are anxious to get those positions filled in our recruitment reported that we did invest some funds through work orders to the department of human resources to get recruitment assistance and it is paying off. we are very happy about that. and you know even recruiting for jeff's position. we were anxious to get this seat

filled. we only will have 2 full tien employee counselors one retire is a problem we have candidates that are interviewed now and hopeful low will be here before jeff leaves. at the end of this month. >> so, that's good news. and -- trying to think if there was anything else. i wanted peek to those were highlights and other things you will see on the agenda. so. that's it. any questions? are there questions of director yant? regarding the director's report? abbie, as the advisory committee

process frames itself i would appreciate may be that we get an over view that you might be able to share about the scope of the work high level information we might better understand. what this entity will be doing. >> yes, ma'am happy to do that. >> thank you. >> are there other questions from board members on the director's report? >> if not we'll take public comment. >> thank you, president scott. public comment is open. instructions are displayed on the screen.

we have one call or the phone line zero in the queue. thank you. no further callers public comment is closed yoochl thank you. let commissioner follansbee get connected and settled before we get back to the committee item. move on now to item 8. financial report. >> agenda item 8 is financial

report as of april 30 of 23. this is a discussion item and presented by chief financial officer. >> good afternoon. the report on the trust fund the balance remains healthy. we are 105 million. we are projecting a 2 million dollars decrease by the end of the year for the year. and for the 10 months through end of april we are ahead the balance trust is up by 10 million due to timing difference and how pay periods fall within the month that will be reversed and the net reduction the end of the year. the net claims in total the medical claims ever higher and one of the plans. access plus. hmo is higher. . the other plans are running ahead lower. so we are not seeing a universal trend it is one plan higher.

the trio plans the claims below and the bpo plan. former rebateos electronic and interest 2-1/2% interests on funds. and the treasury. the sustainability fund 2.7 million balance the end of the year will be higher. because a lot of projects got deferred. the general fund, we are currently rung 1.5 million surplus because of vacancies and the charges from other departments are coming in. some get quarter low. they fall behind. we do expect the year to end favorablely. i will be happy to answer questions. >> questions of the chief financial officer.

i would note they think that i00 autoaudit process is beginning. >> it has started. >> and you expect to get it done by when? >> usually it is done end of september or i don't think we mote in october we present in november. is the plan. >> all right. >> yes. that -- process under way, very important part of our job to make sure when we are reporting is claimed and consider everything and this simple [inaudible] i think you [inaudible]. but they do diligence for -- knowledge of [inaudible] that's part of the diligence and under now. >> thank you. are there other questions or comments for the chief financial receive? if not this is discussion item we will have public comment. >> thank you, president scott.

public comment is open. instructions are displayed on the screen no one has approached we will move to the remote commenters. >> we have one call or the phone line and zero in the queue.

there are no caller instead queue at this time >> thank you, moderator. hearing no callers public comment is closed. >> thank you. we'll move to item 9. agenda item 9, revised general fund budget for the fiscal year 23-24 and the fiscal 24-25. this is a discussion item and will be presented by fshsf chief financial officer. in june the update the board on the results of the major's review of our budget. and i will walk you through what those are. society general -- time line is -- you know the start of the budget process in december and

january. we present to you in february what we think we need00 automayor's staff to look at our budget along with -- all of the cities of the department as well as the forecast. make changes to our budget we will have one step open after this presentation where the budget be reviewed by the board of supervisors finance committee in june. >> the changes made by the mayor asked for a new qc position the condition of the budget and revenues, they are not approving the position. that position was denied. we and do have an option to use our sustainability fund to funds projects to get the work done. so be our considering that.

the were to vac act positions this were removed from the general fund to meet the budget targets for the city. and then nonlabor, we did get additional support from hr because the high vacancy rate this year want to make sure they are filled and then as more openings come up, they are filled quickly such this it does not affect operations. >> the first spernld program started last year, we got funding for -- police and sheriff and fire. and for sheriff we continue on negotiation to get funding from the department and continue that program to next year.

and then the minor election funded the election >> that is not minor when we know there the be vacancies on this board and i would then make an off comment that i trust this we find worthy successors as a result of those elections. >> important event minor financial amount. >> right >> [laughter]. so -- here is the combined budget starting point left year is -- we did are ending up ahead of where we started. and in the current year budgetful we have more funding. but mainly for recruit am. and the enhandled program. and i feel in general it is a good comp moiz in the city's financial position and when they need to carry out our mission.

i can answer questions. >> are there questions from the board? regarding the presentation? >> i have a question. thank you. with regard to the -- sheriff's e ap options i understands that a lot of benefits come through the state of california because of their union set up or how they are set up upon not all city and county. do we get off set from the state with regard to funding some of those benefits such as e ap or do we direct them to a different e ap? so would be the directive from the mayor is that the city is not able to fund what we were asking. the mayor felt and in the past

happened the fire department department has funds from the source. to be able to funds those and because of the destruction they are looking for the cfo. that were we think that we can resthoofl and get the funding. >> okay. thank you. other questions? hearing none we'll go to public comment. thank you, president scott. public comment is open. instructions are displayed on the screen. we'll begin with in person public comment. fred sanchez president protect our benefits. i hear about staffing issues and prebl the most difficult thing faith city government. and all of the departments.

and i understand you know. the deficit and what ask going on and the difficulties. but when we -- advertentlyly go through this and wore at a surplus and things are going good do they replace these -- staffing positions and realize that -- you know you are paying things over time not effective. you get burn out and it is the number one phone call we get from retirees, hey. i can't get into a human body to talk to which i can't understand wham is going on. old are people have a hard time going online and trying to go through forms and stuff. my comment is being is -- hope somehow they can effectively and i speak to supervisor dorsey, he is on that board of supervisors and they know that because how long it takes to h r to hire

somebody. you are not getting somebody to wait 200 days to be approved. you will go on in the private sector. trying to get qualified individuals to come and to the city. recruitment becomes more difficult. so i knowure trying hard but that staffing issue is something that is being addressed in the public sector every where it is critical and we are getting less effective and people don't want to work for the city anymore of be aware of that fact. and we'll help you in any way we can i continue is complex. thank you. >> thank you for your comment. no one else approached we will move on our remote public comment.

opinion comment is closed. we'll take the item number 6. which is the governors committee item we took out of order. so i now turn the chair over to the committee chairman. past pedestrian board commissioner follansbee yoochl thank you very much. our terms of reference we are approved in february of 2022

mandate we elect for a year term a president and vice president of the board. and -- the only restriction as out lined in i think section 201 is that the president and vice president cannot serve for more than 2 consecutive years. we have a president and voip in accomplice now. if any their first year. the i will remind the board that last year it has been the sort of operating standard of the board to have one elected supervisor and one appointed serve in the 2 roles. and left year we made an exception. and so our president and current president and vice president are both appointed commissioners. we ask this is again not standard that we wanted to reset

but this say standard we were indicated was appropriate a year ago. so with that, i would like to open up the nomination this is is an action item. and the new president the president and vice president we elect today will start serving on july first. our terms of reference say first meet nothing july we poe ponent. we will say july first for convenience that is the date listed. with that i like to open up for nominations for president of the board for 23-24. commissioner follansbee like to nominate randy scott to be president. >> second. >> okay. current president scott has been

nominated and i'm seconds. for the 20232023-24 year. for the board and i like to open up the nominations for the vice president. >> mr. chairman i would like to nominate commissioner hao to be the vice president for the coming year. >> second. >> thank you. commissioner hao nominated and seconded for the 2023-24 year. i would like to leave anyone else -- other nominations for president or vice president. move to close nominations >> thank you very much. >> moved and closed do i have a second. >> seconded. >> okay. here is a vote since it is moved. we'll -- i think -- trying to think where we put public comment. may be -- before we actually

have the vote. moved and sejded i like a roll call the commissioners to close nominations for president and violent. president scott? >> aye >> vice president hao. >> aye. >> commissioner breslin. >> aye >> commissioner canning. >> aye >> supervisor dorsey. >> aye >> commissioner follansbee. >> aye >> commissioner zvanski. >> aye >> they are closed. with that, if no further discussion open for public comment and have a final vote after public comment. >> thank you. public comment is open and instructions will be displayed for those on sfgovtv and web ex.

we'll move to remote comment. we have one call or the line and zero in the queue. there are no callers in the public comment queue at this time >> thank you. hearing no callers, public comment is now closed. >> thank you very much. moved and seconded we approve president scott for the 23-24 year as president and moved and

seconded we approve vice president hao as the for form suspicion of violent for the 23-24 year of the health service board. roll call row. >> starting with president scott. >> aye yoochlt vice president hao >> aye yoochl commissioner breslin. >> aye >> commissioner canning. >> aye >> supervisor dorsey. >> aye. >> were follansbee. >> aye >> zvanski. >> aye. >> passes. thank you very much. >> i'd like to thank the board for voting for me to serve for another year. i have enjoyed service on this board since 2013. and. mooim my hope sill will provide the type of leadership and support to our members.

that will be worthy of the service i tried render. so, thank you, again. >> okay and with that, we will now move to item 10. >> request approve the award to consulting inc. for actuarial to health service board and system. contract effective fiscal 23-24. this is an action item and introduced by executive director yant. [inaudible]. >> michael, before you begin. >> this is one of the things that is out of sight and out of mind. every time we go in an rfp press i'm astounded at the amount of work and the requirements of the city we have followed in this

process. michael given great leader help in the pa past and thank you on this effort. we than our actuarial services are something are critical to the work of the board. and we than out of due diligence from a fiduciary responsibility we have been satisfied with the work of the actuary that every 5 years or so we should go to the marketplace and review the standards, process, scope of work, et cetera . so this is when was done. and i like to thank you and your team for what you have don bring this result today. please. >> thank you, president scott. i'm done.

thank you michael and his team have 2 talent the members that have he developed skilsz as well temperature is grit to seat depth of the understanding of the complex process. thank you. >> thank you, director yant. >> with that, and thank you president scott this is michael i'm the contract administration manager for the health service system. over see contracts and procure am. thank you president scott for the introduction. a lot will be a brief covering of september and december. we'll go through quickly i like to start with when we are asking to you approve. recommending the healing service board approve, ratify and conaffirmative award to aon services to provide actuarial and consulting service to the health service board in the san francisco health service system

and authorize to proceed with the negotiation of a contract with aon. >> i'd like to start by discussing our panel. we discuss in the september and december and as was requested by the board including yourself, president scott. we want to have a diverse panel and large are panel than we have done before and exceeded expectations there. 8 member panel. where 3 were from hsf and 5 outside including 2 from other city departments the controller's office and the unified school district and 3 outside subject matter experts. asked us to do a 50/50 split so there is no bias and we far exceeded that requirement in this case. i realist want to note this was a very impressive panelful discussions were tlur organism the interview processil discuss later was extensive.

and all of them not only properly vetted by our team but executed confidentiality statements to ensure this process livid up to the rnlsd stereo president scott spoke to earlier. in september and december i said the scope the service is important torch what the board accomplish every year. you stheen the last of few montes with rate and benefit in years like now and one of the reasons why with the board conditioned fall below the trends with renewals for rate and benefits. they don't just accomplish that this time of year but audits. ensure we are proper fors to trust. compliance and they are critical with plan and forecasting for example when we diameter mental health forum the end of last

year. a recatch schedule. again we issue third degree in january 30. there were 2 adid you understanda required when there are question. . received them and answer all questions submitted. post those questions notify all at the same time. everyone bidding has the same time and the same information when it come to sponses. received 2 proposals from excellent firms aon and the seek walgroup in the public sector space. we had an 8 member panel. begant press reviewing the proposals, scoring across a number of crip tear enthusiasm smith them to us to review and conducted the oral interviews. some of you are fwment oral

interview process i brought over from the contracts of the airport the area billion dollars rfp's there. when we do is ensure that the team that wrote our proposal is the same a team that will provide services to hsh and this board. way to do that is throughout oral introduce provide them 2 questions in advance. hypothetical questions around, issues facing currently. one question at the time of the oral interview. we provide them for that question 10 minutes to collaborate as a team so our will evaluationpable can determine how they work. how they handled the roles. upon one faith medicare rates.

2 were active plans. and again both responded to those really brought a team and it is scores were closely ranked at end of the oral and proposal process. >> again, for our panel members we had 3 from our executive team. the 2 individuals from outside hsf with the city and control and with the usd. and controller both had experience over seeing act iaries and 3 outside panel members represents care alliance and pbgh and equity advisory services. with that i like to open up to

questions and comments. one of the comments about the protest period is this now closed? as of tuesday? >> that's correct the process period ended 11. . 59 last night. no protests for this rfp allow you to begin our contract negotiations and thankfully as part of our rfp we include the p form agreement terms and conscience the standards and our scope. fully flushed out allows my team to very quick plea execute an amendment or in this case a new agreement. following the rfp process. we know we are intends to present this in may now the june meet being. we are can have the we have that new agreement executed prior to july first of this year. >> what will be the term? >> the term for this agreement

will be 3 year term with 2, one year options. you mention today it is a good due diligence to do these regularly the same with health and retiree benefits this will be done every 5 years unless determined by the board. yoot period of time that you site in the presentation longer presentation is that you intend to have this become to us by the first of july? other questions >> could you reaffirm that part of the criteria does with diversity, equity and he inclusion? for all applicants? >> absolutely. diversity and equity inclusionful a key proposal and from our oral interview questions. of >> thank you. minor points -- we are asked to

approve, are the tie and affirm. 3 terms there and i'm confuse body our role in both ratifying and affirm if we approve. could you tell why we are asking to do all 3? >> absolutely. >> as required by rules and terms of reference there are subject matter yours for contract it is. that need to be approved by the board. and this case actuarial is the first on the list. another would be health benefit contracts we did 2 years ago. not just approve but ratify and aif he were you did not understand where the over lap does not exist. >> this is a good question i might defer to the city attorney had is the upon standard terms we always used. >> i can look into it. but -- yea. as to why we use that

language -- >> i would be interested in hearing that explanation. >> me as well. i'm no attorney. thank you. >> thank you. >> thank you. thank you doctor follansbee. i like to thank the 2 members of my team who one taking a deserved break now from our very heavy schedule. the other working on an rfp happening currently and the left questions are due today at noon. patrick chang who came from d. public health and william many of you are familiar does an exceptional job across the rates and benefit's process and contracts. i could not do this without them. these are detailed processes we do them to both the highest extent required by the city and our own standards. i doment to thank them. >> thank you. are there other questions there

were only 2? 2 companies applying for this position? >> that's right. last time we had 4. if you remember in 2018. >> in this case we received a response from the entsities that bid last time that was watson they were declined bid and received the 2. what i notice period about the scoring. if we look back to scoring the last time we did this they were 2 upon that were highly ranked and 2 this did not meet our standards. when we look we feel not only saved time by keeping strict requirements and set a high bar with 2018rfp letting anyone know if you are going to bid understand how active this board is when it come to any ofs that

environment and client rep requires a specific firm. >> thank you. >> you are welcome >> thank you. >> other questions from the board? if not we will have public comment on this. >> i'm sorry. >> i will take a motion. >> >> i -- i move that the health service board approve ratify and confirm the contract award to provide consulting services to the health service board and authorize san francisco health system to proveed with negotiation of a contract. >> second. >> moved and seconded we accept the recommendation of our contract's department. any other questions we take public comment >> thank you president scott. public ment is open.

instructions are on the screen. we will begin with in person comment. we move to remote public comment. we have one call or the line and zero in the queue. we'll wait and clez public commentful for this item.

tler no call are in the queue. >> thank you, hearing no callers public comment is closed. >> thank you. we will have a roll call vote. >> roll call starting with president scott. >> aye >> vice president hao >> aye >> commissioner breslin. >> aye >> commissioner canning >> aye >> supervisor dorsey. >> aye >> commissioner follansbee. >> aye >> and commissioner zvanski. >> aye >> motion carries we welcome aon back. hearing from them during the balance of the meeting. we will now move to item 11 this is a first step in rates and benefits process for the afternoon. agenda item 11 presentation on rate and benefits calendar for year 2024 presented by abbie yant. >> getting close to the end of

rates and benefit calendar and making the decision as we are able to work through the agenda upon today on wlo we will need an additional meeting on the 12th. which of the is tuesday. monday. going to the board of preerz in july i talked to over half the board what they will see so they are not shocked. all right. >> is there comment or question from board on the calendar or the director's comments? >> if not we'll take public comment on this item. >> thank you, president scott. public comment is open instructionsor screen.

in it is a difficult one from00 autoearly retirees especially. because godz i wish we had more time so bring them here to you. to tell you about the impact some considering totally begin up their helling plan they can't afford temperature they are on fixed incomes. get a 2% cola that is it with inflation. they are like. can't afford temperature i rather have them in person to comment they are impacted. . we like the other groups like recsf members who they can bring

forward and we are all in on this together. i never speak for them but -- they are active and if there is anymore way we can have a little baptist an exception to hear the commencements from the impacted individualsed i mean the idea of giving up your health service plan, that seems drastic. so -- it it is a large increase. if there is any way there can be an exception to get input from the people that are actually affected by this decision. >> thank you. we will move to remote public comment. >> we have one caller on the

line and zero in the queue. there are no caller in the queue at this time. >> thank you. public comment is closed. take up item number 12. agenda item 12, helling plans 2024 rate summary medicare and kaiser multiregion retiree healing plan this is is a discussion item and mike clark from am. >> mike.

terrific on work with like on the healing plan and terrific to work with as a service i want to thank him and the board for the confidence you have shown we look forward to working with you for years to come. >> thank you >> this -- discussion item provides an over view to the medicare retiree and kaiser health plan renewals we seek your approval for the 24 plan year. these are medicare advantage plans for the medicare retirees. they are all fully insured plans reviewed today. so each of the health plans provide insured rates for the

programs. including >> both primary and medicare retiree advantage plans from kiez and united health care and the multiregion plans offered early retirees and medicare by kaiser in washington state. the north lost the portland area. and hawaii. to give you a sense on page 3 of the distribution of membership the covered lives base on the 2023 demographics report presented in february. u noticed heck covers 8,000 covered lives retiree and departments. kiez in california through the senior advantage or plan over 14,000. covered lives and then the kaiser multiregion plans for

medicare lives 142. toll over 32,000 individuals covered through the medicare plans offered by sfhsf and 59 early retirees in the kaiser multiregion plans in washington, northwest and hawaii. we'll focus on the learningest plans united health care and the kidnaps plan. over all actions recognize thering is no rate stabilization element to the plans they are insured. we have had favorable rating actionless the last couple of years for the promise. for kaiser in 2023. 1.9% decrease the third consecutive year of rate decrease for the kaiser plan in health care is rare. the 2024 rating action for the

kaiser, california medicare advantage is 6.2% and i will [inaudible]. for united health care there was a 4.7% rate increase in the 23 plan year after a couple years where rates did not change much. a small increase one year a slight decrease another year. going in 2024. 15% increase the talking through with you today. the rational behind that you turn to the next couple of pages, page 5 one of the -- elements that impacting all medicare plan rates for 2024. but just across the industry. and i got a chart and a bid that looks at it. you think the promotium

represent the total cost this does on active employee in early retirees. what happens with medicare advantage the vast majority of the cost is funded by the federal governmentful through you know cms or the centers for medicare and med kate kayed is the branch of the federal government and agency that determines the funding for medicare programs. both you know off sets for traditional medicare plans as well as the funding that goes into the fully insured medicare advantage plans. end of 24 there are 3 major influenceers i say are head wind this is w against the increase levels of funding for the plans relative where they have been in the pastment first, the federal government reduced the over all growth rate to the increase in

funding. for medicare advantage plans. adjustment to per capita caste cost related direct medical and education costs with the service furnish in the medicare advantage enrollees an adjustment will phase in over 3 years with 2025 and 26. this reduced the growth rate 0. 8% for 3 years. the next page. there is a risk adjustment model change. e louded this one of the prior board meeting in maim there is a new approach to how physicians and health system kaptdure dying noveltyic information the 10 classification system. so an advanced methodology

replace will 9 classification simples and long story short this means the medicare advantage plans with this change in approach how code suggest kaptdured in time of service. there is less information known about the disease states condition states of of individuals and so -- with the change removed 2,000 codes from the risk model. mean thering is less ability for the plans to capture this information this guess into how funding is determined. cms giving medicare advantage plan and population. result a medicare risk adjustment coding change. so in addition tote risk scores on page 6. there was also an adjustment change impacted the fungeding

received from new conscience that will merge over time. >> and so all of these transpire to look at the specific advantage and you will see this again in the united health care presentation later this afternoon, if you look at the over all total plan costs the claim and fees that go in the united health care plan, they forecast to increase 6%. we talked about how we see over all general health care trends going up 7%. for medical and prescription drugs. so the 6% is less human from i general trend expectation. the issue is you would think if not a big difference when total costs are expected to go up and cms funding you see by the chart is the majority of the over all plan costs the majority of the

costs is paid for by government. when this source increases by 3.2%, what it means creates increase of when is left and that's the 15% increase -- that is the recommendation today the united health care plan we'll talk more about this when we have our united presentation later today. last page shows the projected 24 cost monthly rates. you have see comparison side by side of the kaiser program in california to united health care plan. in the only california have access to kaiser but retirees living throughouts the united states where this may be the only plan offered to that retrieree. kaiser premiums are lower because of the hmo model.

tirety management in the hmo model with kaiser system approach. you know upon the u knifed health care plan is a national ppo. capturing as much data on members as they can. but expected to have a higher cost and the cost gap between kaiser and u nighted health care will widen the renewals. you see in the table. toll plan rates include 3 dollar sustain ability fee and the premiums at the top. employer contributions determined by application of city charter formula.

ghee in specifics on each of these changes. so if you got more detailed questions -- please holds those. this is about the general trends and impacts we have seen across the board. doctor follansbee you opened update nest why this is increasing. you know i want to point there are almost 4,000 advantage plans. not all are available in california. there remember 6% increase in 2022 this is an area where health care company it is find that they can may be maximize

their profits. we talk about supply and see medicare getting out of the medical education funding puts a burden on medical centers the schools. a time when we worry about supply of providers the universities and medical schoolers hit harder now. they can't ask for help from the government x. likewise thing decrease in funding -- the

increase to be honest is something that is real when politicians talk about preserving medicare they do it with their tongue and cheek. this is an active form of under mining -- a federal government funding decrease the increase. i wanted ask, when you go back to look at the benefit. certain benefits ruled in the increase from some of the providers over the last few years. one of them being meals after discharge. that was a new benefit then

rolled in the rates the year after and we never hear about the benefits weigh pay for and how much they are utilized and how much we are paying for these and if 30 successful. i have one friends who has united health care throughout city and county retiree and her experience with post discharge meals was less then and there ideal in terms of the quality, fact they were delivered in 25 boxes to the front door she could not get in the door. baudz of her surge row and months after surgery they were reinitiated and she to being her awhile on the phone to navigate this. multiple phone calls we are paying for this service.

when you go to plans to negotiate rate system there analysis of when we are getting for some of the added costs? >> yea. we worked with the plans. tracked the cost when we look at the kaiser presentation well is an element that decreased in part of over all premium looking at the equalization of the cost of the benefit we can come back in august with information to present to you. to the board on what we are tracking for equalization. you are correct post charge meal deliver. transportation benefits, post discharge and as well as to and from appointments. things of this nature. you know that are part of the over all benefits that various times have been add in the the

programs. are there other questions. general questions about the presentation? from the board. >> yes. thank you. i want to make a comment. and that -- all of the makes this difficult and to add to it there are 11,000 people a day age nothing medicare. and we did have a result of the imppact of the pandemic our life spans decreased. that will come become and as we have an aging population some of the add-on services that -- may not have been used to heavily during the pandemic i think we want to put context. people age in place at home. the services will be more

important. i think we always have to zoom in and out on the types of service. and be sure weave look in the context of times we are in. >> thank you. i have a comment. >> united heck and twice it was okay one time they did not show xupt next time sketchy the driver and stump i don't know something was not right. so -- that's my experience. a good idea for people who mead it but if not being used i called them to say they did not show up this day that was all. so as far as the meals i don't know how that works but -- okay we'll look forward to summary report based on the

equalization. >> we will have that. >> thank you. >> are there other questions from the board if not we will take public comment on this item. thank you president scott. public comment is open. instructionos the screen. we now move to remote public comment. we have one caller on the phone and zero in the queue.

board secretary there are no callers in the queue at this time. >> thank you. hearing no callers, public comment is closed. >> thank you. my experience at the meeting the mind can only comprehend what the end can endure. and as a result we are going to take a recess at this time for 15 call the roll and procedures for public comment. thank you president scott. roll call vote starting with president scott. >> here >> vice president ho.

not a roll call. roll call >> no vote. >> voip hao wrochl present >> commissioner breslin >> present >> commissioner canning wrchl present. why supervisor dorsey. >> present. >> commissioner follansbee. >> present. >> and commissioner zvanski. >> present. we are quorum. instructions for public comment is streaming on the screen.

00 president scott? we'll take up item 13. >> agenda item 13 rerue and approve kaiser multiregion medical rx retiree hm oshg plans 24 rate and contributions. this is an action item and presented by mike clark. >> mike clark. aon presenting on the kaiser retire yee multiregion renewal for washington state, northwest

and hawaii. these plans introduced in 2018. starting on page 3. new kaiser plans for retirees that live here outside of california kaiser has plans available. again, washington state is one region the northwest which is the portland area and southwest washington and hawaii the third. that will present in this request today. >> looking at page 4u see the number of covered members retirees and medicare inspects in the plans. there are dozs dozen per region and barbiturate for thez retirees when live here. in total the premium for 2024 is approximately 1 million,

779,000. you see at b. page 4 the rate change actions proposed today. which rink from no change for the washington early retirees to a 9.9% function for the northwest early retirees and departments >> page five when you average everything the early retirees averaged a 6.3 prz increase in rates and medicare retirees a 4 opinion 5 next in rates. they are mall populationings we reviewed the rates are determined by kaiser. and the rate changes aggregate and below national health care cost increased trends. and then we add in the basic plan vision premiums as well as the 3 dollar health care funds charge. and for the medicare, the rates

will be adjusted from year to year to funds reconciliations for how funding finalizes. relative to what is the known at the period of time of gifrn the rates are communicated from early before the cms funding is come leastly finalized. the cards reflect the full contributions for medical cover available to retired employees. hired before 20 where are 9 for disability and spouse or surviving domestic partners. the medical coverage is available to retired employees hired on or universal january 10 of where are 9 with 5 but not 10 years of service.

with the employers and surviving spouses and partners. on page 8 for other retirees who were hired after january 10 of 2009 there is partial employer contribution available relative to the city charterer formula for those with greater than 10 and less than 15 years of service received 50% of the full city charter rate and those with greater then and there 15 years and less than 20 receive 75% of the rate. rate cards themselves starting on page 9 for washington state showing theary retirees on the left side of the ping and the medicare retirees on the right side. working through the city county contribution form wells for the county amount applies in full for early retirees.

approved the merchandise 23rd meeting. for the medicare retiree its is limited to the full cost full total rate for retiree only coverage for medicare retirees and easier on page 10 is the change in proposed monthly contributions the top of the chart as well as employer contributions in the middle of the page and the total rates at the b. page for early retiree and medicare on the right side. where again washington state there is no change in the rates for early retirees. medicare retirees a 5% increase. the northwest region on page 11 the rate card i will ask to you approve today. page 12 a bit easier to see with the change in rates.

washington rate were positively influenced by a significant decrease on demographic factor. so that's why a zero percent change on the early retiree rates for washington the change in the composition of membership and it is a mall membership in that plan, north west had a more typical kaiser rating trend for the cycle. and for hawaii, page 13 is the hawaii rate card. proposed for 2024. page 13 and page 14 shows the change in contributions and total cost rates where the early retiree increase 7.3%. medicare rate increases are. 9%. with that on page 15 i will close with staff recommendation the health service board approve the kaiser 24 plan year rate and

premium contributions for multiregion hmo plans for early retiree and medicare retirees. as presents in the this proposal. of president scott. >> are there schedules regarding the presentation or comments? from the board. >> one brief question are you in the position to discuss other plans if they experience similar increases for the time service they provide. >> certainly. society only plans available to retiree in these geographies the early retirees, it is pp oshg plan. nonmedicare pp oshg plan that was reviewed the last meeting where that plan did benefit from the legal settlement dollars. the rate increase for this plan was 1.7% and then the medicare

retirees the other plan is united health care medicare advantage with 15% increase. these rates for the medicare retirees are lower than the united health care advantage plans. >> thank you. other questions? i'm willing to entertain a motion. i move we approve the 24 plan year rate for hmo plans for early and medicare retirees washington, northwest and hawaii regions. and related rate cards. >> and related rate cards. >> is there a second? >> second. >> properly moved and second. is there further comments from the board? regarding the motion?

if not, we will now take public comment. thank you, president scott. public comment is open. instructions are displayed on the screen. we will move to remote public comment. board sect we have one call and zero in the queue.

there issue no callers. public ment is now closed. >> thank you. we'll have a roll call vote. president scott. >> aye >> vice president hao >> aye. >> commissioner breslin. >> aye. >> commissioner canning. >> aye. >> supervisor dorsey. >> aye. >> commissioner follansbee. >> aye yoochl commissioner zvanski. >> aye. >> passes unanimously. we'll move to item 14 on the agenda. agenda item 14, rerue and approve kaiser senior advantage california. medical rx fully insured medicare retiree hmo plan. this is an action item and presented by mike clark with aon

yoochl mike clark, presenting the rate renewal and rate cards for the kaiser senior advantage plan. in california. opening to page 3 with the staff recommendation go through the details staff recommends the service board sept kaiser senior advantage medicare retiree rate card. includes 6.19% sured premium increase. as we discussed in my first presentation there were 14, 197 medicare eligible retirees enrolled per february 23 demographic report. since 2014 as requested, kiez pro vieds an estimate for the medicare retiree rate in rate

card development. on page 5. you see the various elements of the rate development how it changes from 2023 to 24. there was a 1.86% rate decrease from 2022 to 23. the third consecutive renewal particular. 2023 rate in accomplice the build rate on the page 304 dollars. now if -- if kaiser had known what the final funding would be that rate would have been lower. so there is a beneficial prior year reconsill yigz apply instead 24 rate that is the second row in the table. 9. 43. the early 24 rate production before added programs and before apply side 323 dollars. the rates for the added programs so -- may be a bit of precursor

to when we'll hair in august. 9.24 and includes chiropractors benefit. silver and fitness beg your pardon enhanced transportation rider includes gurney support and meal delivery. firecall the enhanced transportation ryeder reducing by half for 2024. the details with you in august but that was based on kaiser reassessing the actual cost of that transportation program was done. >> when the final map was done with the member premium rate with the added program costs for members and comper seed the premium for 23, you know the 24

premium is 322 may be 3 cents per member per month. 6.19% increase in the bill. again. page 6 is reminder that this is an early estimate. there will be a reconciliation done by kaiser later in the year. be applied 2025 rate this is is a risk rated population for medicare the final rate could be higher or lower than estimates applied. the dpr goal of kieztory have the rate give close to possible. under page 7 a baptist commentary on the rate under loyaling trends are higher we discussed throughout the rate and benefits siechl kaiser is impacted by reductions in increase in cms funding they

will not quite as much as united health care because of the kaiser staff model where -- there is -- the direct and inneraction with members and the staff hmo environment relative to the ppo environment that is united health care there is the favorable reconciliation helping this year. would be higher without that reconciliation adjust am. the end state is 6 opinion 19 premium next for medicare member and maked medicare families the nonmedicare portion is based on 12 and a half % premium increase per left meeting and the basic vision premiums are not changing from 23 as well as the 3 dollars funds charge under the rate cards. i will not read it again the same apply as we talked, the

rate cards are shown for earning the full city charter contribution. recognizing there are individuals don't earn a city charter contribution or earn a partial contribution. i will go to move ahead to page 10. so page 10 is the rate card. i'm asking to you approve today. showing the various premium component. the vision basic vision cost, expense and application of the city charter contribution. to create the net contributions for the member. for 2024. or for comparison see page 11 to look at month low retiree contributions in total rates from a year to the next. i am close staff recommends

service board sept med compare rate card as presentlied including the 6.19% insured increase to the 24 plan year president scott? are there questions. our actuary regarding the presentation and content or provisions there to? yes. i want to thank you for again, remining us about the reconciliation. i'm a little we fails the same issue. i understand without this reconciliation if zero or right on -- the rate increase may have been higher? is this -- >> correct. would have been in the 9 to 10% range. >> yea. >> other questions from the board members? hearing none a motion? moved. >> second.

properly moved and seconded sept staff recommendation to accept the kaiser senior advantage medicare rate card as presented today includes a 6.19% insured premium increase for the plan year 2024. etch comments or questions from the board? we take public comment. thank you, president scott. public comment is open. instructions are displayed on the screen. we will move to the remote comment.

there are no callers in the queue. public ment is closed >> roll call vote president scott? >> aye. >> vice president hao. >> aye. >> commissioner breslin. >> aye >> commissioner canning >> aye >> supervisor dorsey >> aye >> commissioner fol bee. >> aye >> commissioner zvanski. >> ayech >> passes unanimously.

we are ready for item 15. agenda item felony reruand approve u noticed medicare rx fully insured medicare ppo plan 2024 rate and contributions an action item and presented by mike clark with aon. >> mike clark, aon. we will present the recommendation for the united health care medicare advantage prescription drubbing plan for 2024. starting on page 3 staff recommends the board sept medicare advantage prescription drug medicare rate card. presented today. including i 15.0% premium increase in the 24 plan year. >> the count in the plan 17, 990 total medicare retirees enrolled in the plan.

united health care 2024 rates. in the footnote. whatever reason don't qualify not enough working service during the lifetime you see that document in the the footnote. there say part b only rate notoriety 138 vsed of 897.14 per member per mont. the over all rate increase is 15% following the 4.7 increase. where we talked about earlier i will talk about in this discussion. the renewal is magified by the change of methodology the

federal government using for cms for medicaid payment in thes 24 plans. the nonmedicare retirees in the united health care plan as well as the nonmedicare retirees one family member enroll in the the plan. uhc is that add administrator for the split family medicare retirees with nonmedicare family members. you can see the nonmedicare family members do have a choice of 3 plans. through united health care. when at least one family member is enrolled in the plan. so that is the select network the broader ep oshg plan the same rates at blue cheeld access plus. narrow network doctors epo the same as blue cheeld trio plan

and the nonmedicare and choice not available you see that definition have the same rates the blue cheeld come medicare ppo plan. yao will see this in the rate cards we will presently available to the nonmedicare family members. plan premiums are significantly higher. with 15% increase. to summarize, reduction in the growth rate in the plans. each the next 3 years in 2024. 0.8% per year. hoping page 7 number 2, is the risk ajustment model change going from the i cv, 10 whichesification system losing information on submit covered lives and a risk adjustment

coding change a third item that is also in will impacting the funding receive for new conscience over time the same chart that we presented a couple presentations ago look at the leverage the reduced level cms funding increase has to what is left the plan premium over all total costs of the plan increasing sick % and stip the majority of the plan paid for through federal government funding oldsmobile increasing 3. 2 percent credits leverage on what is left for the promotium that cascades and that drives the 15. 0% increase. upon the presentation this we have today does contain upon

design change we evaluated for this plan. current united health care plan has a lower proirm care office visit. $5. and special office visit of $15 the copace for the services in the kaiser senior advantage plan. the proirm care and specialist office visit copayments are $20. so they are also low in united heck plan than in bench americas gifrn the high rate renewal increase presented by uhc, staff did review and consider a plan design change proposed by uhc increase the office visit copays by $5 per visit for proirm and special care. primary care to $10 and special to $20 this . could have

lowered the needed rate increase to 14.1% instead of 15% or 0.9% additional. [inaudible]. 100,000 applied reduce retiree contributions covering within or more department and 800 thousand employer costs. but on page 10 is documented here sdaf staph does not recommend the plan changes. the funding for medicare plans based on scores driven by claims data collected primarily at annual wellness visit at home or the office. and h encouraged to attend wellness visits where health status can be recorded. the change is 50 dollars in annual premium reduction.

over 4 dollars per member per month. of fit dollars a year break even talking about a 5 dollar visit change. would have reflected 10 annual primary care or special office copace. increasing the primary care provider copay may reduce equalization with low copay. we are thinking what else can be done to encourage primary care. staff will schedule a healing service board topic on planning design later this year >> mike, while you are there, do you have a number at the off the top of your head the average number of office visits that a person goes per year. >> unfortunately i don't. i heard 7. i have to look.

thank you for the question and i wish hi that. >> thank you. thank you. so looking ahead page 11 -- the -- the rate cards are based on no change in plan design. i talked earlier the rate card has mixed medicare family columns for the variations where the nun medicare covered lives can enroll.

2023 mixed care will not be available in the 24 plan year for the medicare health net planful 12 and 13 cover information rate cards and some who questions of law foil for no or partial city contributions. the rate cards on page 14 shoes the premiums medicare members on the left and the full families in the mixed medicare families in this instance is 2 in medicare. 1 plus family member and nonmed care there are other example in thes appendicesic i will in the review them to show the comparison in member contributions for maked medicare families in other tier s.

what is the change admit member contribution the -- among low employer and total cost rate for all medicare members and family situations as well as full family 2 are in medicare one plus are non. i will close on page 16 staff recommend you sept u noticed medicare retiree rate card for plan design presented today including 15% insured premium increase in the 2024 plan year. president scott. >> are there questions regarding the presentation. i was looking at page 14.

you have one plus nonin uhc-ep o lisz then and there in select ppo. what is the difference there? >> so the different plan. that is one selects the nonmedicare covered lives and the difference has grown select applies to increase that is consistent with access plus, for this cycle, the ppo rate increase was 1.7%. so, there was a difference between the rate increase on the nonmedicare covered lives in the families.

that is add administratively difficult when tell be more able to peek to this. but it is part of the evaluation of moving the mixed medicare family nonmedicare lives to uhc plan administration and, way from blue shield. plan administration approved left year for 1123 the decision was med at that time to not allow the nonmedicare to enroll for reasons that lead to that decision. to move the lives away and 2 united health care.

we would have to undoe when we did a year ago temperature is tremendous low difficult for us and the plan. we have 800 lives impacted by that project and we came to the conclusion this was the reasonable way to administer that benefitment we were doing some of it via spreadsheet tracking the movements of the people of i'm ready to accept a motion. >> president scott i move we sept staff recommendation -- to

for the uhc medicare -- plan rate cards for the status quo plan design including 15% insured premium increase to 24 plan year. >> second. moved and second we sept staff recommendation as presented. are there questions from the board? hearing 91 we will take public comment. >> thank you, president scott. public s comment is open. instructions are on the screen.

i could have come occupy then and fraevenl frustration just mild. i think -- i'm one individual speak for an organization but i continuing is about education. and when i see there is only one person on the line just listening that person never said anything tells me the education piece has not been there. i will w with retirement organizations i chose not to go to the meeting today a conflict at the same time as your meeting that gets the gray panthers and the other organizations involved concerned about health care tremendous low.

so at this body it is late for things. you know i'm encourages about -- speaking about -- looking for policy shifts and -- income based costs and member is thinking here it is about education. police take it become to the provide and ares the city leaders and you know one individual was expressing when many feel and zee to educate them to get them involved. nothing moves unless people get involve today is like you gotta vote. that is part of the education piece. >> thank you.

you must dial star 3 if you wish to join public comment. we wait and close public comment. public men is closed. >> roll call, president scott. >> aye >> vice president hao >> aye >> commissioner breslin. >> aye >> commissioner canning. >> aye yoochl supervisor dorsey. >> aye >> commissioner follansbee. why aye >> commissioner zvanski. >> aye yoochl passes unanimously. thank you, mike for you and your

team and the work and diligence you put forward in this process to bring us to the point this year >> thank you a terrific effort with the team. >> thank you. >> buffer leave i like to ask a question. how many early retirees there are left month it was early retirees 5, 417 is that with or without departments. y believe that is the figure in kaiser. with departments. if i remember correctly. virto ask >> this total early retirees. i was not clear if with departments or not. >> um -- i have to go back and look at the demographic report. page -- i don't have that information. why page 5. yea. i don't have the may 25 presentation with me.

to confirm. >> all right. commissioner breslin. i'm concern body it nothing to do with today the rates for people with 2 departments i wanted to find out how many early retirees violate plus 2 in that category. this is kind of becoming not affordable for early retirees. the charter states retirees are included and i -- have to go back to the charter. i don't know. it is clear in the statement the intent is for retirees raft same health care. with the exception of the union agreements, et cetera. i don't know.

my recommendation runs demographic report because it does show detail boy plan and tier. for each populations. so, that would be my recommended source. for that information. you will send it, karen and go over with you. so you can have the answer. i will send you the report of the as far as numbers of the charter. iot numbers of the early retirees. >> okay. >> we can review charter language i recall it peeks the retiree and their department not i don't think an so it? on departments? >> can't recall. we can look. the intent it is [inaudible] we

need to look at our at the chart exert rely on the executive director to do that and follow up. thank you. >> other comments? if in the we will go to item 16. vote on whether or not to cancel the july 23 regular meeting an action item and presented by executive director yant. >> i ask the executive director to address whether we will reconrein this board in are a special meeting on monday june 12 at 1 o'clock. you recommend this we cancel the june 12 meeting and we cancel the july whatever the date. meeting. >> all right. you heard the recommendation. is there a motion? i move that we cancel the hold

on the june 12 and special meeting. health service board and regular meeting for july 23. is there a second. >> second. >> discussion? i said i hope not. of no sduchlgz with that we are ready for public comment of instructions are on the screen. begin with in person public comment. we'll move to remote public comment. we are one caller on the line and zero in the queue.

there are no caller in the queue at this time yoochl public comment is closed. thank you. we'll go to item 17. i'm sorry. a vote is need. roll call, president scott. >> aye >> vice president hao. >> aye >> commissioner breslin. >> aye yoochl commissioner canning. >> aye >> supervisor dorsey. >> ayech >> commissioner follansbee. >> aye >> commissioner zvanski. >> aye >> passes unanimously. now proceed to item 17.

>> agenda item 17 report and updates from health plan representatives a discussion item. you would like to have all of the planned representatives that are in the room to stand. if you would. on behalf the healing service system board like to thank you for your hard work and diligence and patience with us throughout this renewal cycle. and i can only assure that you we will get to know each other better as we go forward. thank you for your attendance today and the cooperation you provided throughout the year. thank you. you may be seated. is there public comment on the nonpublic comment from the plan representatives. >> i want to ask if blue shield here? nawas here last week and look

the in the trio issues? >> we did have locked bo tiwill get the name of the person so we can research a bit. more on that. because the side is not away. we will have more details for you hopefully in the next board meeting. it it is a serious problem. i mean the doctor does not know who to refer to. >> one person they is no okay and go to the other person, no copay. this is primarily with ct scans

or anything like that. sorry did not know the last part the mri's or ct scans. okay. they don't know where to refer the people >> okay. used to be a lot of confusion. nobodiness what is going on. and then the concierge service has not worked well. will have a large learning curve to figure out which of these places are available to the things. should in the be a learning term we have a tool what has the information in there. and so we still need figure out what happened in the situation. it seems to be a one off then

and there a learning are issue. >> look forward to get being that report. convene again. that's how it guess. we find out how it works is through the members. >> right. appreciate that. and so now we have the information we'll look into thisch >> all right. >> thank you for your attendance today and thank you commissioner breslin for bring thanksgiving up and look forward to more information. >> no not for you. we heard a plan to reach out to membership of retirees to educate them and engaged in the healing plan. i think i want to urge you we kept copays down for upon proirm care providers and to try to help influence the drivers and

increased heck costs we see. i got a response from covering my primary about the events when it might be available but lots of things done prosecute active low to alert or membership to changes happening to the importance of screening. we know fallen down during covid and have not caught up in any of the healing plans in terms of screening for breast cancer. heart disease. hypertension. colon cancer. i urge you to join in the commitment of education to

members and that will happen benefit everyone the health plan and membership and the health. please, make that commitment again and like to see proactive education to all the members about what is available and will be available soon. members don't have to have things fall off their own wish list. for the future. thank you. thank you with this -- we stand adjourned. until august

>> the meeting am come to order the support june 92023 of budget and financeful i'm supervisor chan chair, i'm joined by rafael mandelman and shortly supervisor safai. our clerk is brent