Transcripts For SFGTV Government Access Programming 20171117

Service there because a lot of them are going to bring the packets and they will want to process their open enrollment onsite. So, we would appreciate it if that would be available. Also, we like to acknowledge the hard work that goes into this. Marinas description was a little bit overwhelming, and i think none of us really appreciate the extent to which the finance group and arenas group, and all the staff really get involved when it comes to open enrollment , and this is just the preparation phase. We understand the processing at the other and is also quite overwhelming. So, they just need to know that retirees are extremely grateful for the services. We do have a lot of elderlythere was when i got an email. Hes 80 and his wife is 90 and theyre coming in from sonoma and they want to be able to process their open enrollment on october 11. Thats more typical some of the members that will be coming to this event and we appreciate all the assistance and support we get. Thank you. Thank you. Director griggs, youve heard the request and i think that was available last year if im not mistaken. Yes. At our ccs the event will have [inaudible] i will be there. All right. I will encourage members of the board, if you have the opportunity and your schedule permits you see the calendar, maybe a more confirmed calendar distributed that you take the opportunity to actually go to some of these meetings and actually meet the members and hear their concerns and their issues. So i thought it would be very beneficial last year as i did wonder to myself. Are there any other Public Comment . Hearing and see none, would like to thank you and the team for what youve done today. We will move on to our next discussion item. Item six, action item, approval of revisions to Health Service system membership rolls. Acting director griggs. Mitchell griggs acting director of Health Service system. Every year we bring to you are member roles we have revised. Those roles are usually good for the plan year. Now are looking at rolls for 2018. We have to Public Notice this because it is a change to membership rules and the members have to be aware. Then we presented in a public forum so they can hear those changes as well is give you an opportunity to approve those changes. This year, for our member rules, we are looking at going through, routinely go through and change the dates to make sure all the dates are consistent with a plan year we are discussing. But, the court changes are listed here in a summary. So, in section b pages 911, we are updating the rule on the dependent certification criteria. So, its quite a messy change if you look at the member rules. I summarized it on the next page for you. We extracted the actual rule and put the number of revise on the last on the original on the right. Overall, this change is specifically addressing the fact that in the original version, we required dependents to be enrolled on hss plan one year before they turned age 19, and to be enrolled the entire time between ages 19 and 26 in a age out, as a dependent would. So, over the years we received complaints about that that that was extremely conjured an compared to other plans. And municipalities and counties run the area and no one has that rule. Based on the research that we did back years ago when dependents were covered up to the age of 19 then it moved to 23 and the Affordable Care act and moved to age 26, i believe the purpose of this was to just make sure that the dependent was dependent on the member still and not some other entity or some other person. But we do cover that as far as financial dependency within the rule. The other significant change in this definition of dependent is we are having the health plans determine disability. Previously, members had to send in medical documentation certification with diagnoses and procedures and treatments to the Health Service system. Our office. We would have to review for disability. Then [inaudible] clinicians. To make that determination and the gray areas was rather difficult we do not want to keep medical information and clean information within the Health Service system for confidentiality reasons. The health plans are the ones that have this medical information. They are able to do this work they do it for all their other groups. And mos, benefits and administration places that have disabled dependent coverage have the health plan review. For disability. So the other part of this rule as requiring the members to comply with that process. This is not take away any of their appeal rights. If they do not like to determination the plans give they could do a first level appeal with us and then of course if they dont agree with our with you what then it would be aboard appeal. I think thats critically important to stress that point is that i dont want to insult our health plan partners, but to say there might be some skepticism on the part of members about how determination might be made, it could be problematic. So a member does have a right to appeal once a determination is made. I think we need to kind of highlight that in some way in thiswith these rule changes okay. We can certainly do that i would agree with that because i dont think we ask with each health plan review for us what their policy is and what criteria they use. Do they use the same criteria across all the help lens. To my knowledge we are not required or requested that we need to make sure that there is no glaring differences. Right. So what we did and implemented started implement and is without plans, as we did review the criteria to make sure they were all on the same level, as well as the timing. We want 60 days before they urge 26 thats a general rule. Some of them are, so its between 60 and 90 days. The criteria like that we have reviewed ourselves. The health plans do that at no additional cost. Another rule that we have is from time to time that disability may need to be recertified so they will also be performing that for us. In the past, weve never been able to comply with that part of our own compliance rule, is to be certified individuals. So that is the main change in the rules this year. I think it puts us a lot more in line with the other public sectors in a lease in our region. Right. Questions . Commissioner follansbee im confused by your question about recertification. When i read this it says recertification process says every year and thereafter and then upon request. So it sounds like every Year Health Plan has to recertified, whichthats not actually what i thought her but maybe i heard wrong . So, yes our rules do say every year, or upon request. It probably should say, instead of saying, and, it should say, or, on request because we may not get to it every year. But it could be yes. All right. Other questions from the board regarding any of the rule changes . If not, i want to highlight to those wonder change which we do every year. We change the cover periods in the index in the back of the rules which is the second one on your summary. Right. Any other questions . I am willing to takeentertain a motion to i move we accept the change. Is there a second second. Properly moved in second we accept the changes as presented for the rulesin the rules, for the plan year 2018. Any further discussion by members of the board . Any Public Comment . Hearing and see no Public Comment were ready to vote. All those in favor say, aye. [chorus of ayes. ] opposed, nay. The motion carried unanimously. [gavel] im going to stop here for minutes because i think we created an egregious error. We dont have a finance report. Its going to be in december. In december . Okay. I like to have the cfo come to the podium for just a moment. I know youre not ready to give us a full report, pamela, but can you tell us how the audit is going . Pamela levin chief Financial Officer Health Service system. The audit is actually going really well. We had a meeting with the auditor just yesterday. We are ahead of schedule. The city wants to issue on october 23 it looks like will be issuing on october 20, which is last year we were the first out of the gate, but then again, we dont compare i think things are very different between sfo and and of course the hospitals. The review of the triangles with the claims, we have had some issues with that before. Several years ago with blue shield, all of that has been completely smoothed over. It is very simplified, and it actually took about two weeks where last year it took 34 weeks. So we were very happy about that. So far, they have not found anything. Wethe interesting thing thats going on right now is some of the sampling now that we dont have a file room, they want to still see some files in physical kind of things been weve been trying to figure out how to make a virtual file room, a file room in the sense of doing sampling. We are trying to move forward with automation and we dont always consider everything. Otherwise, we finished all our entries. There could be one entry that im kind of putting my foot down in front of the Comptrollers Office and saying i dont think we should do it. So im really happy with it. Its fairly smooth considering the fact that we did prepay our vendors over 43 million for july and june, which required some finessing to make sure that when the actual trial balances come out in our financial statements, they are not skewed because of that. That we could explain that. There was a lot of advance work done with the auditors to make sure that would work. All right. Thank you for the update. I also want to publicly commend you and your staff are the trauma of the summer called Financial System change. There was a massive Accounting System change here in the city and county of San Francisco that impacted every department and every element of the charter accounts and i know that pamela and her team were in a very center of that effort to get it right on behalf of the members, and i commend you and your team for sticking it out and slogging through all that. Thank you. We are still working on some of the really abnormalities of our requests. Every department has Something Special and right now we have Something Special that we are not sure how that is going to work out in the end, but its been a long haul. My staff has done a wonderful job and in many cases, we were ahead a lot of the departments in being able to issue payments and purchase orders. So, thank you thank you very much and please, convey the thanks on behalf of the board to the team. I will. All right. We have been at this for a little while. Im going to take the risk that the head cannot endure more than the feet can stand so will have a five minute action item number seven. Item seven action item approval of section 125 cafeteria plan update acting director griggs. Mitchell griggs acting director Health Service system. Again every year we have to present any changes that we do for cafeteria Plan Document. Again, he needs to be publicly notice and changes need to be brought up in a public forum. These are very simple changes this year. There is no significant change. On page 30, if you look at your summary that i gave you, we updated the name to the acting executive director. It was a prior executive directors nameon the execution section of the Plan Document. We also updated section 85. 2. We do this every year. It is putting in the values with the flex credits which are currently paid to the Municipal Executive Association and representative employees that have the same types of benefits. So its just the flex credit paid biweekly to these employees. Lastly, appendix e we updated the benefit program table. The reason we needed to do this is the addition of the blue shield 30 plan. That section lists all of our plans, the policy numbers, pretax or posttax type of plans, so we updated the Vision Service premier plan and also blue shield trio within that, as well as there has been some changes in policy numbers in preand post tax status like [inaudible] like pet insurance and legal assistance, that type of thing. So we did some updates from last year. That is all the changes for the cafeteria Plan Document for 2018. In regard to the report from the acting executive director, what is your pleasure . I move the except the reports. Its been moved reset the recommendation for recommended changes as presented second. In there is a second it probably moved and seconded. Are the questions from the board . Commissioner sheehy so i want to ask about the United Healthcare. Theyre now requiring prior authorization for people who request preexposure prophylaxis to prevent hiv. I think that dr. Follansbee is familiar with up to kaiser has been a leader in providing out to their patients and after literally hundreds of thousands of patients, patient expenses, theyve have yet to have an infection. So im curious as to why july 1 of this year United Healthcare no longer routinely provided [inaudible] [coughing] its a proven fda approved proven intervention to prevent hiv infection. Thanks for bringing that commissioner, supervisor sheehy. We can look into that. Thats not something im aware at the moment. We also can either at this moment have United Healthcare account rep speak to that were at another item, i believe its 12 when the plans come up and talk about any changes. Is are represented from United Healthcare here . Okay. Will hold until that time. [inaudible off mic]. Would you step up to the microphone since you are speaking and identify yourself, please . Thank you. Heather jean with United Healthcare. I am happy to get that information and get back to you but its not something i am aware of and we dont have United Healthcare representative works with city and county of San Francisco with us. So not having been on the agenda im happy to find out that information and back to and i report that to mitchell but i dont have information on it today. Thank you. Any other questions from the board regarding changes . Is there any Public Comment . Hearing and see no Public Comment we are now ready to vote. All those in favor say, aye. [chorus of ayes. ] opposed, nay. It carries unanimously. [gavel] we have discussion item 8. Item eight discussion item, dependent eligibility verification audit project to certified eligibility and dependent spouses and domestic partners. Aon hewitts. Just before aon hewitt comes up i just want to preface it but just a little bit. We discussed having a dependent eligibility verification audit. I believe it was late last year the [inaudible] was going to be about six months or so fire to open enrollment due to significant changes with open enrollment we move the schedule. So were going with the implementation in january which aon hewitt will discuss that but i want to let you know the last time we did any type of dependent eligibility verification was back in 2010 and that was just a a sampling . No. It was all dependence but all you had to do was sign and certify they were still eligible. Amnesty. That was the word i was looking for. Given the definitions of what the dependence are if you meet that definition you should opt in or face penalties. We did not ask for any supporting documentation to showthat continually eligible. So it was recently reasonably successful but it was just an amnesty project. I would say industry standards for benefit administration would say population of our say should be to one of these every 35 years. That being said aon hewitt can continue the presentation. All right. Thank you. Good afternoon good afternoon pres. Scott and supervisors. You are . My name is rocky you do what . I work on dependent verification and been working with mitchell and some others here and coming up with information in relationship to eligibility, what you can expect. I also do an overview what the Employee Experience will be like. The projecct itself and some of the other things. Thank you very much. Thank you. First off, as well is the value of and audits, its one cost avoidance. Theres obviously a cost to carry those that are ineligible and carrying those on your plans. By eliminating the cost it helps prevent, or i should say, preserve future costs for expenditures and benefits area. From a fiduciary standpoint, the only thing the benefits to eligible participants and their beneficiaries. Certainly, minimization of claim by not having to carry those that are not eligible for the plan. In protecting those employees certainly, those are doing what has been asked of them has been following the rules. One of the other things that come through, as far as value here, employees, we from this with an understanding what eligibility rules are. Its an education process. So many times i would say the employees are carrying ineligible is just because theyre not understand what the rules are. An example of that might be say i am married and get a divorce. Part of the divorce decree might be they need to maintain a Health Insurance for my styles. Given that situation, the decree does not say i need to keep them on my employers plan just as i need to keep them insured but people automatically think they need to keep them on their employees plan. Thats how sometimes we carry in eligibles and by lack of information so the education helps to clear that up. As far as our experience, weve done over 700 audits it weve done over 7 million dependent verifications and i thought it would just share some i just want clarification on the. Somebody gets divorced, theyve a court order to make [inaudible] spouse or children or whatever. Why wouldnt they keep them on . It depends on what the plan rules are. What are the rules . So if you are legally separated or divorced, youre no longer in eligible dependents. So even if theres a court order, that court order is with the member is not with the Health Service system. There are things they could do private insurance or cobra or Something Like that, but our definition of a dependent, a legally married dependent spouse is if they become divorced legally separated or it is a dissolution of marriage is issued than there are no longer eligible for hss i thought there eligible after divorce. I do not know that. I think we would keep them on because it dependence, children especially the children, do. Its a natural born child, if its a stepchild, no. But if it is a natural born child is still dependent whoever the member is even though they may not be divorce. Thats part of this member education aspect. I presume we are going to be about your broderick mitigation plan to all of our membership about how this is going to be done and so forth . Absolutely. Why this is important, 70 of the healthcare spend is spent on dependence versus total cost. We see the average of 4100 and that would be the cost for caring each dependent. So when we look at some of the savings generally will see between five and 7 for some audits or have audits that have not been performed for the last three years. There are some particular savings there. Go to the next area. The way our program is set up, theres going be client manager assigned to hss and that person is going to be responsible for the project from end to end. They will be able to provide some introductory webinars, providing Key Information to those Key Stakeholders iin regards to what the project is about, communication pieces, frequently asked questions, goals of the program and so forth. Really, is basically letting the team know that what the project is about and that it should they come across employees looking for direction, to either direct them to either the Customer Service line, or, over to the website for services to help them get there dependent verified. Theres also a client portal and ill be showing that. We will show you the full transparency to the team. So everybody is clear as far as all the information goes on the Verification Program. Here is a idea of athe timeline as we set forth at this point. We can certainly change this around, but this is kind of what we have outlined from this point forward. A 90 day implementation generally from january 2march 31. Then, during that time we will be working on some of the medication pieces, setting up the data it changes so that we get the information of the dependents and sending it back to you. We are going to be working with you to find out what type of communications you will find acceptable and thats one of the things that all takes place during the requirement stage. Then amnesty period thats where the employees understand that they are going to be asked to submit documentation and with that, its a letter that goes out to help them understand to prepare gather some of this information. Then, this Verification Program is a 60 days and during that time that you get notified through different letters, as well as though get a phone call halfway through if we have not heard from any of the employees. Then, at the end, we actually have what we call the silent grace period as we know a lot of times people way to the very end before taking any type of action. Rebuilt in a 30 day extension so we can help them employees to that particular process through the end of a good during the tempo of customer support, Customer Care. Theres going to be reporting that is going to be done. I spent a little time with that as well. As i mentioned data going back and forth. We realize that the employees are the most important asset of every organization and with that we develop the program to make it easy for employees to verify their dependence. We start over on the lefthand side there, it could be as easy as taking a picture of a document with your mobile phone and then going ahead and submitting it. We can correspond to emails. Weve got a website for selfservice where they can access info, information. They can also upload documents. If they want to handle it just from the [coughing] we send out they could call the directions we provide to them in a letter that gets mailed to them. Weve got a Customer Care team that provides information to anybody who wants to know whywith the program is about, how they might be able to locate a birth certificate in another state or marriage certificate in another country or Something Like that. So weve got a customer unit to do that. We also have a secondary layer of assistance. Our system is so smart, we can tell when people have tried to verify the dependency through online, or, sending documents. If we see if theyre having trouble what we will do is automatically allowed to that participant and to do introduce ourselves and let them know we are there to help so might be understand the eligibility rules, answer questions they might have, help them to source the documents they when he completion of the verification. So, we take that extra step because we realize its important to help employees go through the process. We look at this as a way, really, to get everybody verified. We are not out for a witchhunt or anything like object want to help the employees get the information they need so they can submit and prove the eligibility. Is this going to cover 100 of the dependents or will it just be a sampling . This will be the spouses and domestic partners. Only no dependent children at this time no dependent children . Correct. Then, as far as the portal itself, its 247. Theres a secure mailbox i mentioned before. The employees can upload the documents directly to that. Our Customer Call Center is available mondayfriday 5 am8 pm pacific time. Customer care representatives specifically work on dependent verification. They dont do any other function so other experts in the area. We have language support lines, which will help with the 160 languages. So if someone needs assistance in another language were able to help that way as well. When an percent of our calls recorded. Certainly we have tty assistance for the hearing impaired. I think we can skip to the next slide. This is the landing page for the selfservice. So that an employee whats going to happen is they receive that letter first letter they will get his talk about the amnesty program. Were, the other her neck. However hhs would like to refer to it will refer to it in that manner. The second letter that goes out is actually the letter that tells them about the project itself. Its going direct them to either complete the information based on the letter they received, or, go to the website and they can pull additional information. So at that point this is the landing page on the top lefthand corner. Youll see the employees name and then you will see the listing of all the letters that have been sent out and generated to that employee. So if they want to print it, want to view it, if they want us to reprint and resend it to them we will definitely do that. Underneath that, if they chose they would like to only receive email information, through electronic methods, we would do that and not necessarily mail out. Going across the top, you will see where it says documentation resources. As i mentioned before, the Customer Service team gets a call regarding finding a birth surrogate or marriage license from another state, county, country, we can supply assistance to do that. That same information is here and a dropdown area where you put in a particularitll give you information on where the sources at an as well as how much it costs you need to get for example a birth certificate from a particular county. Then, as well, going across the top, the documents commission, if you scan in your document and like you submitted you do it from there. Underneath there, if you take a look at a dependent verification status is going to show all the dependents listed underneath that particular employee. It will show the type that they are and as well if they been verified or not. Underneath that, you will also see the documents we received and then as well, any documents that need to be reviewed that there still in hospital a lot of times people want to make sure hey, did you receive it . If you received it is being worked on and so forth. Thats a fully to help you boys be fully aware of where what they cemented and where it is in the process. This is the client administrator portal. This is where hss team really we could have full transparency of the entire project. We collect all data so that we could slice and dice any information, any bits of information you like. We have over 40 different reports. If you like report we dont have we will write a report it will create it for you. Then, one nice thing about this, rulesbased axis. If theres some people you want to be able to see certain things, they would be able to view the information that is here on the portal. The information can be global or it could be very granular to the point if you want to see a particular area of the organization was, as far as what percentage of employees have been verified dependents, too, you want to see particular dependent has been verified by the employee be able to look at [inaudible] for that employee. Then as far as the Field Support will take care of level oneness so that if an employee calls us and asks that they feel their dependent should be put onto the program, we will go ahead and send out a letter for them to do so. With that, we will get that information, reviewed, and respond back to that employee. If they decide to take it to the next level where it would be an appeal what we will do is prepare all the information that we have looked at for the claim and then provide that back to hss and then at that point, go ahead and provide you really all the information you need to make that decision. Then, lastly, here this is commonly im asked what type of documents do you use and this is really just an example of what has been used is commonly. But as it gets down to the requirements, we will find out from you what you would like to utilize. Usually, its common for using both a document to substantiate the relationship, let us say, for example, a marriage license, and then something to substantiate that it still in place and i might be a tax return. Were any type of financial document commissioner breslin with the use to verify the marriage is typically in place . Be some type of document that would show interfinancial dependency. We could use whatever you would like to use. So we have some organizations i might say a joint bank account, or, some may ask a tax return would show. So we would work with your organization to find out exactly what you would like to use as acceptable documentation so how do you verify in domestic partners that there is a certificate and you have to fill out a form there living with me . Sure. What we would do is work with you to find out what you would like to utilize to substantiate that. Presently, its just a form but nowthey are swear to or whatever. So, why would that change . So if youd like we can use the affidavit if thats what youre using today director craigs director gregs when someone wants to add a dependent theres documentation thats required. There is been probably, at least since catherine. Has been director 10 years or so ago, if youre are trying to add your legally married spouse after provide a marriage certificate. So thats the first verification process. Thats the only thing is a signed marriage license. Domestic partners might you have to have either the city of San Francisco domestic partner certification. So we dont certify that relationship in San Francisco or the california state domestic partner certification process, or, other state certification. I believe we accept other state or suggest california . Other states, too, yes. So, that relationship is certified by one of those governing entities and not the Health Service system. What we would do in this verification process like the example brought up earlier as we want towe want you to tell us that marriagethat you are still married we wwant that to ms. Domestic partner certified with the state is still that domestic partner relationship. But we would ask for, like rocky said, is either some type of mutual financial joint banking account, or, an irs form for domestic partners . For the domestic partner certification, in order to do that theres things we have to provide to the state but you dont need to have joint bank account . No. You dont need to have irs no. You dont need to but in order to certify with the city and county of San Francisco or the state, you do provide things that show some type of joint living together or some type of domicile things like utility bill for instance is one of the things you have to submit for domestic partners. So that is something we would request for domestic partners to provide one of those documents that they typically provide for certification [inaudible crosstalking] i hate to interrupt but i cant getthere are also state of california issues Domestic Partnerships that i believe there any requirements so youll be adding a new requirement . Those documents might be required by the city and county of San Francisco, but my recollection is Domestic Partnership, my husband and i got did not require supporting signed by kevin sally. I dont it was a burden. I think the Domestic Partnership thing is really challenging because you are trying to, frankly, impose heterosexual norms on relationships that are explicitly outside of heterosexual norms. So there may not be living together. They may not on stuff together. But this is a relationship of mutual dependency. So youre going to ask him for things that are separate. Many peoplethere are people i know who dont believe in marriage. So,i just have to say i know why you do this but i just got through doing this with my prior employer and you are basically asking people to do work to get something theyre legally entitled to. You have to be very cognizant of that. You have to bezero asking people to go stew stuff. These benefits are ours by right. I justi dont know if anybody has been through that employer dependent spouses verification thing, but ive been through it twice and ive got to tell you, the first time i went through it, i thought they were trying to take away my benefits because i was a samesex couple. The education that needs to go one that needs to take place in our Diverse Community i just think it has to be incredibly incredibly sensitive and just the idea of take taking away their Health Insurance is kind ofdoesnt feel like the most wonderful thing in the world. I also wonder what is going to happen with the retirees. Are they part of this . Are they going to have to reverify there included its all members [inaudible off mic]. Well then howdo you have special ways to do with that . Sure. So what if the former employee has alzheimers and youre sending stuff to the person. Your sending stuff to that personand yet their spouse, you know,the ramifications, for retirees im especially nervous because this is all mail. Theres no direct outreach. So people dont catch it in the mail. So i missed it. I got a call. If i had been relying totally on mail, i wouldve lost my benefits but am legally entitled to. So, i just think it would be great to talk to folks who we serve before we implement this. Because im going to have to do this, right . Right . Im going to be doing this. Commissioner, i think your point has been taken. I would directthis is not the first time this type of effort has been done. Maybe the first time in seven years in the city and county of San Francisco well, i think the last time is noted was not a full audit. It was justyou asked the people had responded you just assume they were legal, am i correct right. They did have to recertify saying they are dependent at the time still needs the criteria. But i do not have to provide documentation they did not have to provide documentation they just had to check the box right. Your point is taken and theres something was Due Diligence about especially in terms of domestic partners. The other aspect of this, however, this board has fiduciary responsibility to ensure that members are members. So, we haveits not to say you do that at any cost in any way you want to him about we have a responsibility to do both things, to regard the members and their sensitivities and circumstances, at the same time perform a fiduciary obligations to the trust. So its both those challenges and i think your point that you are making is one that has to be incorporated in plans and the approach and the implementation of this. You know theres two ways to do Something Like this. To make sure that no one who has somebody who should be on their plan. The other is to make sure that you dont needlessly cut somebody off whose legally entitled. So you can do this in a wayit is justi understand you want a rigorous process, but the default should always be to try to make sure that everyone who is legally entitled gets it because you can be fairly draconian on this and hey, the deadline goes out and you do not do it and there goes your stuff and you have to spend a lot of time getting back what is yours. Thats really what im trying to push for becausethis feels like a corporate situation and a corporate situations its do or die and we are family here in San Francisco and i think we need to be very sensitive to taking care of each other. Point is well made. Yes . I think some of the confusion might be about the appeal process. Im assuming appeals would come first to the Health Service system personnel but ultimately, we are the final arbiter of the third level of appeal, i think. So i think ultimately, my understanding is if we were to take someone off they would have to come to us if they were continuing to object to the determination of lack of dependency they would come to us as a Health Service budget is that correct that is correct. The safeguard would be in thisi do not see it explicitly here,and ive gone through these processes before, that there is a pause point you will come to a point where you will find people do not have the appropriate documentation and might be a subset of retirees and actives. Its at that juncture, before any action is taken that this board wants to be advised. So you can go out and you run the gamut. Youve made phone calls and youve done the letters and so forth but before any action is taken to remove any dependent that has been identified as a dependent, thats where the starting point is. So we are fully informed of the numbers under the circumstances, some sort of grasp of this as a board before letters are sent to individual saying, you are off. They have to go through an appeal process. That creates, to me, a level of stress that may or may not be warranted as a consequence of this. Im putting that out as a stakeholder, milestone before we take the action of sane, sending out letters, saying, you are terminated, i want this board informed formally with a report of the scope, circumstances, not at the level of revealing individual cases , but kind of whats going on here and what will be the consequence. I want to be sure that is clearly a part of the project. The other thing ive not heard, who is going to manage this internally . We have a project manager from aon hewitt. I do this internally . I would say you director gregs well, a couple things. The mailings that will be going out and receiving information can either be done electronically. People can uploaded electronically or send it into whole mailing and checking the mailing has been received or the second going going out is going to be handled by aon hewitt as well. So when all that is gathered and the results are given to us and we would reviewwe can review it anytime during this process through the employer portal that rocky mentionand they would deliver the results and the data files to us and documents. If theres any particular dependent. Again, the first level appeal, they would advise us first level appeal we would work with him on making the decision and also the second level appeal that would come directly to us. All right. We done so many these projects. We know where the percentages of employees that have verified the dependence and where they should be at any given time. So if we need to put in an additional email if we have email addresses we could do that. We do have the ability 247 to run those reports. We are some organizations where they make certain areas reach out to those employees. So youre fully aware of whos been through the process and it is not. We also, in addition to the minutes, their phone calls like about to let the employees know that something has been generated to them regarding the verification project. I know a lot of other organizations, they supplement do it with some other information i might be going out during enrollment or anything that appeared i guess it is to this point director gregs, this is going to happen starting roughly around january through june of next year . Thats the timeline i would say so implementation starts in january. The mailings wont go out until the end of march april but the process will then go to perhaps august when we wrap it up. Well, i think it would be prudent to give people a heads up if we are thinking about doing this even during the open enrollment period. At a minimum on the website or some footnote to make them aware but then there and some line of communication that is consistent and ongoing once we are in it right. All right. Any other questions from the board commissioner lim [inaudible] are the legal spouses and domestic partners . Yes. How about those employees and retirees that have this added domestic partner or legal spouse within the last six months, or eight months, or nine months. They still be [inaudible] because they submitted the dock nation at that time would just be a certification for those that have been less than a year . Good question will work with you in the requirement stage and if you wanted to we could include them or if you didnt want we would exclude them. We would look at a reasonable amount of time. Its not necessary people are certified recently or some amount of time we need to do it again because weve been through that process no. Because all they will say i send you the documentation six months ago. But you have to in a letter [inaudible] yes. Commissioner sass yes. Is this a service aon hewitt is providing or is there a separate fee for this engagement . There is a separate fee. Has anyone told us without the is . Is that something we should know . I can get that you. I dont have it off the top of my head right now. He was pamela leven, do you have a sense of how much this is going to cost director gregs, somebody . Pamela leven chief Financial Officer. We are not paying for this. Its been paid for by the Comptrollers Office from the money that is required for them to collect for the city Service Auditors function. Several years ago there was a an initiative that was passed that allowed usi do remember the percentagesa small percentage of the budgetto go into a fund that would be used to for projects such as this that would save money that would move the city forward in terms of automation that would move the city towards providing better service, that sort of thing. So we worked with the Comptrollers Office and got on their schedule and they are going to send it. All right. Thank you. I know that my recent question in some minds but we will go forward without extra nation. Any other questions from the board on this project . Any Public Comment . Thank you ffor your presentation. We will look forward to the next steps. All right. We will now go to another discussion item. Item nine discussion item, update on blue shields trio hmo implementation. Blue shield representative. Hello there. If we can go to the slide deck again you are . Jeanette mode with blue shield california. So, it was asked that with a trio implantation we provide an update at every Board Meeting and thats the intent of what i want to go over right now. I did though want to address questions brought up earlier in the meeting related to the redirection of [inaudible] mentors to nonsolder of facilities. To add to what was already said about that topic, redirecting by brown and tolan is not new to them. That they have been doing this for many many years. There is one key blue shield account they currently do it for today as well as one other carrier they have done it for. So it is hard coded into the system okay. Thank you for that. There was also a question regarding folks been onsite during open enrollment to you want to address that . We got it indirectly lets hear from you. Yes. Is our intent to ever own boots on the ground at the hss office. Remember where Member Services when will that begin . Will be doing that during the month of january. I think were planning two weeks and perhaps three if necessary. It will be two people. We actually envisioned having a high level Customer Service representative as well as someone who specializes specifically in eligibility. Will you be present like that during the open element process and people are trying to figure out do i want to do this or not . We are actually in all the open meetings and fares at all the locations with multiple representatives at each. Im talking about someone in the Office Taking calls coming in . You know, i dont think we had plan on doing that. We do have our shield Concierge Services their accustomed train specifically for the trio population, as well as our regular Customer Service which, today access members call into which are being versed in identifying in the event the question, line of question may be related to trio as opposed to excess, plus commander trained to do a warm transfer to the concierge team. Okay. Thank you. Commissioner breslin when you send out this material, some material, you have a phone number in their four blue shield, or not . Yes. We do. All the materials they sent out related to trio have the trio shield concierge number on them. I know people will be using their phone a lot of times yes. Were hopeful they do. Of course, were also reaching out to all the members who are being auto enroll. Were reaching to out to all those households. I think were doing three phone calls total to reach them. I will make sure people are able to be reached by the phone. Because they may do that rather than call hss we hopeful they will call us. However, were training hss on how to manage those phone calls and also how to warm transfer them to us. A second question. Can family members of a mix of trail and access . The trio product is just like offering the uh uhc pbl product were offering kaiser the entire family enrolled in the product. Okay. So with all or nothing . That is correct. And we justjust to makke it clear for everyone there is no auto enrollment of the singlefamily for a Single Member does not currently use a trio primary care physician. The only folks being auto enrolled are already using the trio providers. Okay. So prior to this they could makethey could have two separate yes. Continuing on they could haveso the access plus is a large universe of providers. A subset of that universe is trio providers. So, today, theres tens of thousands of hsss families who can be made up of a mix. We are calling it a mix where they have some trio provider pcps and some access plus pcps. In that situation, they will remain in active plus and of course they may elect to go into trio. But, should they elect to go into trio every Single Family member need to choose the trio primary care physician. Does that make sense . Yes. It does so proceed with your report, please. All right. So marina has a presentation up here. Just to review the objectives, to introduce trio and address employee questions and concerns , provide targeted communications to key audiences, partner with the aco partners which is per donnelly brown and tolan, ucsf hill and dignity, to support ohe events and community with members and provide hss and if it Staff Support and training around the product. I thinki dont think you want me to go through all these pages again. No. Okay. Good. Lets flip to slide 10, please slide 10. We are going to slide 10. I thought maybe just an update on where we are that would be wonderful. Thank you so much all right. So, the training for sf hss is we are beginning to put together those slides and we are working with siobhan and whats most important to them. The sf hss mailing, the oe kit and benefit information, those are divided. That is an hss luncheon and we are still working on having the oe kit actually published and mailed in the meantime, they did put out the imit invitation to the benefit and protect information meetings being held. They were discussed early in the meeti one at the whitcomb in the evening and one at the library in the evening. Both during nonbusiness hours and weve already begun receiving rsvps. We are happy to see theres engagement there. People seen the communications and we will have a good attendance at both events. It is actually our hope that theboth rooms get filled and we look forward to doing additional vents because article is to engage everyone as much as possible. Our targeted member, weve already identified various less. We very different letters going out to different members based on different circumstances as a relates to their trio enrollment were not trio enrollment as of tuesday. We have those lists and those letters be dropping in the mail in late september in coordination with the hhs communication schedule facebook apps will be appearing at open enrollment at the beginning of october. Of course, blue shield is supporting open enrollment event support at all the locations and we are actually adding a new partner to this and that is dignity. So they will also be attending some of these events and we think thats exciting and a good opportunity. We have the benefit information meetings on the 10th and 18th of october and then welcome to medications we going out in january. In addition, begin with open enrollment our show concierge will be contacting all of those members were being automatically enrolled. Again, were looking at doing three phone calls total. Only living one message though because people get sensitive about having multiple messages left. Is that the end of your report . It is. Any questions he was any questions from the board . Commissioner follansbee sorry i sound like a