Currently doing. You are promoting on your plan resource section the delta dental wellness highlight. So both of the flyers are on your website and you also have a smile way Program Section and it actually gives the instructions to members on how they can and role in the plan. And then what i didnt put on here, and im so sorry, but you did promote smile way. You have, both in the retiree and the active benefit guides for 2020. You have a paragraph and there is a smile way pattern on there. And also there is a little footer on the benefit summary page in case they didnt read the content. There is a reference on the benefit highlight peace as well. You also previously promoted the smile way program in your in the news section on your website as of april 11th. So some future possibilities or considerations on how we can continue to promote this wellness benefit, one would be to add how to enrolled in the smalley program on your dedicated page within delta dental. So i gave the website we have a specific website that is just for your membership, and by going out to and doing the little slash, that will take you directly to your delta dental webpage and it has you benefit highlight sheets on there, your evidence of coverage, and then smile way and some other things. So just putting the two flyers front and centre on that page, so i am working internally to do that as we speak. Retiree outreach. I dont know if there is an Association Newsletter or meetings or presentations that could possibly that i could attend or provide content. Targeted messaging, so emails to actives and retirees who have signed up for the delta dental online account, or have an online account with us. We are capturing when you create your own line delta dental accounts through the enrollee portal, we capture your email address. It most likely is probably a personal ad just. We have the capability of being able to target messages to you. When they use the cost estimate estimator tool, it will bring up what deductibles they have satisfied, how much they have used of their annual maximum, and it will then calculate the benefit that they are looking at. So we have a number of different suggested, soto of the most common such as a feeling, or a crown, or braces, and it will actually bring up who they last saw so the dentist that they last sought services from, and then it will calculate for them what that outofpocket cost versus what we, delta dental, will pay for that procedure. So on your next page, this is the staff as of the launch date on january through september. So for actives we have 367 utilizers, and for retirees, we have 61. And the dental procedure inquiry , that means out of that active 367 users, they looked at two different procedures. They may have looked at a cleaning and what the cost of that is, and a feeling for braces and a crown. And so you can see retirees were looking at a couple of additional. They may have been looking at the implant versus the crown and one other. So we continued to publicize this benefit as well during your health affairs. So i think these numbers will also increase by yearend. Does this cover also youre out of plan dentist or only your premier and p. P. O. . Very good question. It actually shows when a member is going in and selecting, such as a filling. They will show the latest dentist and that will show whether it is an in network, a p. P. O. Premier dentists, or a noncontracted dentist. It will then list three or four in network, contracted dentists, and then it will do outofnetwork. Is a great tool to shop for your dentist for Major Services because you are not locked into a dentist. You can go to anyone. So it really demonstrates by utilizing that p. P. O. Or premier dentist comparative to someone that is just noncontracted with us. Oh, the next slide we have active utilization and retiree utilization. This was specific to cleanings. We were talking about engaging members and getting their cleanings, and then just some other how they are utilizing the services. Whether it is a basic service or a major or orthodontic. So for actives, we have the first part which is your cleaning procedures, and so 36point 5 have not received a cleaning. That is what that none means and then 42 have received at least one cleaning for yeartodate. So as you know, we are kind of in that cycle of getting that second remainder of the year. Usually you do it every six months. These members these numbers could increase a little bit from the none to one or none to two. Also, then the next line is your basic services. That would be fillings. Twentyeight utilization there. Major services would be more like a crown. 9 and orthodontic. Your active plan has a 2500 calendar year maximum, so 41 we looked at the membership and the utilization there, 2. 4 were exceeding the 2500. That is still a very low number. We usually look at a 10 threshold as to then we need to start looking at increasing the annual maximum to a higher amount. And then the final piece on this particular slide is the network utilization. So 38 using p. P. O. , 58 premier , then you have the 3 for noncontracted. Just a comment on the slide. It is kind of strange that you have 36. 5 of the reimbursed who havent even gone to the dentist i dont know what is going on with those numbers. You should at least have at least one cleaning or two cleanings a year. It is kind of strange that we have 36. 5. Thank you. We agree. It is a free, covered 100 benefit, everyone should get one cleaning a year. And an exam to identify other problems within your mouth. How much outreach is there . That is a great question as well. We actually Just Launched a campaign to really focus on the cleanings and getting more individuals that havent sought cleanings to go and, as a fronting reminder. So i am working with your executive team to determine if we will establish or push that campaign out. It is basically an email campaign. So that is something that we Just Launched and we are slowly but surely getting clients on board. This is going to be a health issue, as well when you dont take care of your teeth. Correct. We have talked several times would delta dental and have an ongoing conversation about how to do a deep dive into understanding why people dont go to the dentist. I think we all have our theories and i think it is important that we continue engaging our membership through focus groups or surveys or whatever to try and understand what the barriers are because it is an Alarming Number of people that are not having basic services and it can and will lead to other health problems. I think it is a huge indicator of a Preventive Service that is disappointingly underutilized. It is something i think we will continue to work on. Thank you. Your next slide is on retirees. Almost 33 of people are not getting cleanings, 36. 2 for one cleaning, and for individuals that have had at least one basic service, 35 . One major service, 18 , and individuals that are exceeding the 1,250, sixpoint 1 . And then your utilization for p. P. O. Versus premier versus non contracted dentist is 41 versus 53 and then five are going noncontracted. That concludes my presentation i am more than happy to take any additional questions. I have a question. I have a tough time figuring out what is the difference between the premier and outofnetwork because the cost is much the same for the member, you know, the outofpocket cost is pretty much the same. I am wondering why, what is the difference between a premier and in outofnetwork . Right. The cost is premium. There is a very big difference in the experience to the member. So for anyone that is going to a p. P. O. Or a premier contracted dentist through delta dental, when they go and Seek Services from that contracted dentist, all the paperwork is taken care of for them. So they come in, they are already precertified in the Dentist Office make sure they know what benefits that member has and is eligible for. They then create or have the exam or whatever the circumstance and theyre coming in for a filling. They are having that procedure done. The dentist submits that procedure and that claim to us and we process that claim and then we send an explanation of benefit statement indicating here is how much we paid, heres how much your cost is. Now lets take the experience of someone that is noncontracted with us. A dentist, you still have the ability and you can see from the numbers that youve got a population that is still utilizing noncontracted dentists , so when they go and Seek Services, that dentist will either call us ahead of time to verify that theyve got coverage or not. When they had their procedures done, the member will have to pay 100 of that cost upfront. That member will have to submit their own claim form to us to get reimbursed or, in essence, basically to find out how much we will pay on that claim, and the dentist can balance the bill so we have contracted amounts of what we consider as contracted fees or contract allowance for a filling or a crown. With a noncontract dentist we have no ruling over them or governing power over them, so if they charge what we consider exceeding the allowance, they actually can balance built the member. So lets say that cleaning was 100, and the noncontract dentist charges 120, we pay 100 that 20 will be balance billed to the member. And what is the difference in the premier and the p. P. O. As far as how they get reimbursed from you or what they can charge there are two different contract arrangements. Premier was what we started out with way, way back. Many of our dentists are still premier dentists. However, we have now negotiated different rates on the p. P. O. Contract to afford the dentist having more access, meaning just to the members, and it is also giving a discount to the members when they are going and seeking services from that p. P. O. Dentist, as well as our clients. So actually h. S. S. , every year that is a reimbursement. We shared those savings with h. S. S. In our premium and in our overall cost to you. So are the premier dentists paid less by you . They are paid a little bit more. All right. And so you say you have pretty good oversight over the dentist if they are having problems or if somebody comes to you with an issue with a dentist, you will carry it out. In the past i have had at least three incidents and nothing was really ever done. My dentist had serious problems. And they are still practising. So i dont know how it is today or how much oversight there is. We would definitely want to know that specific dentist. Hopefully the member or yourself has called into our Customer Service and reported. They did at the time, absolutely. Because then there is a report that is generated and then that goes back to our specific unit. We have secret shoppers that go out to those particular dentists we are sharing. As i mentioned, enrollee satisfaction, as well as different surveys that we are doing, and if theres anyone that has had a number of complaints, we reevaluate our relationship and we have cancelled the contracts in the past for it not being up to our standard. I hope so. Thank you. Any other questions . Thank you for the information any Public Comment on this item . Seeing none, Public Comment is closed. All right. Now item number 12, please. Approve this s. Of h. S. S. Infertility benefit clarification. This is an action item. Good afternoon, commissioners you have received in your package, and we can display for the public if you wish the memo that i have written to you regarding the modification of the infertility benefit. We have had this discussion several times at the board and many discussions with our plans and the time in between and i appreciate everyones patience and persistence in seeing this discussion go through. As you know, we approved and infertility benefit in 2017 and since that time, we have seen the benefits administration of that, too, and we have been noticing that we have some difficulties with one of our health plans in the way the benefit was being administered and it caused us to do a deep dive in understanding how benefits were being administered by the plans. And it was very enlightening to go through this inquiry. There is a grid that we are contract staff have prepared for you to see the list of benefits that are or services that are covered under the infertility benefit and again we found an opportunity to both clarify and add some services to that benefit. So today, im asking for the board to approve these Additional Services and to support the clarification statement that i have written in the document in that, as i said, these questions that have arisen early are around procedures that are in Current Practice being considered diagnostic. So the clarification statement is that these Services Covered under the infertility benefit that was approved in 2017 is required so h. S. S. Can continue to ensure that covered Infertility Services are available to all members regardless of age, domestic partner status, gender, gender identity, marital status, genetic information, sex or sexual orientation. Situations when a member require services to determine the member s ability to achieve or cause pregnancy, the least Invasive Services are diagnostic in nature and may lead to ruling in or out to the diagnosis of infertility. So this decision to proceed with these services is often determined by the member in consultation with the members physician and so we are making these clarifying statements to ensure these services are available to all members. The added services that you will find on the grid are the oral medications, injectable hormones and intrauterine insemination. So we continued to have really robust conversations and relationships with our plans, all three. Blue shield in particular has been very forthright and aggressive in identifying barriers to the Proper Administration of this benefit and are taking steps to ensure that that is corrected and that our members are not running into problems as we have now uncovered that there had been some. So with that, i hope that this clarifies for the board what we recognize is a situation in which the plans are really willing to properly administer this benefit so it is available to all our members and this clarification discussion has been quite beneficial to all parties involved. Can you just clarify, in terms of you alluded to the fact that one of the plans if there had been problems and you have been working diligently with them to identify them, maybe look for denials that, in fact, were reported to h. S. S. To look to see if there are other bigger problems. Are there complaints from the other two health plans . Or is it limited to one plan . We have not received complaints regarding the Health Plan Coverage at kaiser nor with unitedhealth. And we have the one member who has come forth regarding the concerns of blue shield and has been a very strong advocate and is very, very helpful in informing us and blue shield where the barriers have that she has experienced as barriers. So, as in some of these other situations that were mentioned under previous agenda items here , it is always hard to find problems when you dont have specifics. So blue shield has been very helpful in trying to find any denials that they have record of and they now have a case manager who is dedicated to our account and to this benefit to investigate all of those and reach out to the members to get the full story because they may or may not have been appropriate we dont know at this circumstance. I share the concern that sometimes wordofmouth advertising can be your best friend or your worst enemy. I do think that in the circumstance, we will work with the plan to make sure that our members are aware that this benefit is available to them. Again, just to reiterate, we have mechanisms when there are concerns over denial of benefit, et cetera, that we have h. S. S. Staff that can field those and help go through the process to make sure that those benefits are understood or appropriated, and then the board would know what the outcomes were if there were problems that were presented that we need to correct. Absolutely. A key service that Member Services provides is taking this call from members that are having all kinds of questions and struggles. In fact, i know a number of the Board Members have called on behalf of members and we take those quite seriously. We are able to be a strong advocate for members and are really wanting to do that. As you know in our Strategic Plan, we did call for an additional position of the Communications Director who we are actually calling an engagement specialist because we know 126,000 members are not all the same, and theres various different issues whether it be the underutilization of dental care, the misunderstanding and negative experience with the ministration of a benefit. We have a wide range of issues that we have to do a better job communicating with our members. We are in a good position to assist us in doing that. With regards to this action item, if the board passes it, what would be the difference of experience be for members who are trying to utilize this benefit. The aim is to limit any benefit to things that currently exist. Okay. So you were going to give more of a presentation on this . Anton is. I was here to be called upon as needed. Does anyone need any more information on this . I would entertain a motion. I move we accept the staff recommendation to approve and clarify the infertility benefit. I second. Second. Is there any Public Comment on this item . Hi there. Good afternoon. I wanted to thank the department and the commission. I know this has taken up a lot of time that was unexpected time i did send an email this morning. I dont have a medical background, i am not part of the insurance company, and so i understand that it is incredibly complicated and i appreciate your work. Having said that, is one of the most senior legislative aides here at city hall, i know a little bit about policy. When policies are made, typically there is a problem identified and backed by data like in this case. There is the goal that you want, which is, in this case, his equity and access to all members without barriers. And then you create a policy to address both the problem and to get you at your goal. In this case, there are no changes being made to the current policy at hand. What is being recommended today is a change in language for clarification. So the language, just like a policy, the language needs to be incredibly clear so theres no room for interpretation. I think this line is what the director read and it is getting at the crux of the problem, which is that at least the least Invasive Services are diagnostic so they can be covered, which i think gets at the issue that was shared. However, i want to point out that in all the other documents, it clearly says that in order for the service to be covered, it must be determined to be medically necessary. So my question to you is a lesbian couple or someone who is a single mom by choice does not necessarily have infertility, but does need access to Reproductive Technology in order to conceive. So is this saying that an iu why can can be used as diagnostic before they have a medical diagnosis, are they going to be reimbursed . Do they have access to this before the diagnosis . It is unclear to me, but that is less important. It is more important if it is clear to you as commissioners of the department and to the insurance providers. That is my Public Comment. Thank you. Any other Public Comment on this item . Can i comment on this . I think it is clear to me because i was concerned from some of our previous discussions around the use of the word fertility and infertility. After some discussion, and have encoded a lot of encounters, there are preliminary encounters of diagnoses such as infertility so if a woman were to come in with the desire to be pregnant and in a lesbian couple or a single woman or whatever situation it maybe, if they would be infertile until proven fertile and if the procedure led to pregnancy, then you wouldnt put them on a permanent problem list of infertility, but that problem that was coded for that encounter would, in fact, solve be considered payable. The diagnosis can be changed. So if someone does not need a permit diagnosis of infertility from now until ever, and i asked specifically, what about if a woman came in and had had one successful pregnancy through whatever means, and was now desiring pregnancy again for the same kind of circumstances of having had one pregnancy, would she be considered fertile or infertile . And given the circumstances would be considered infertile at that point, even though she had had because this is a new encounter. It is a new time. I think that this covers the situations that might arise that would be again, it is not a permanent diagnosis of infertility by any diagnostic criteria. It is a situational situational diagnosis. We would cover two episodes. But apparently not the third. But it would cover because we wouldnt know at the beginning it would be infertile. Whether it is the first pregnancy or the second. That is my understanding. I have assurances of that. And obviously if that is not the case, we would hear about that quickly and have to amend the policy as we needed to to make it clear. We have all kinds of avenues to gather these problems as they occur. I am comfortable with this in the situation that has been outlined. Thank you. All right. It has been approved. It has been moved and seconded to approve the info tenant infertility benefit clarification. All those in favor . Aye. Any opposed . It is unanimous. All right. Item number 13 please. Item 13 is reports and updates from contracted health plan representatives. Hello. I am with blue shield of california. I just wanted to provide a Network Update for our access plus trio networks here in san francisco. On october 1st, we sent a letter to 1500 members of our access plus plan to let them know that 48 primary care would be leaving the medical Group Effective december 31st for in and forming a new i. P. A. Under sutter. So we were not notified of this change, but in order to comply with our department of managed healthcare compliance for 60 day notification, we went ahead and sent letters out to all of those members who were impacted on november 1st. At this time was still have not been formally notified that these positions will in fact, be leaving. We are assuming that it will, in fact, take place, which is in violation of their contract with us. So what we have asked them to do is to provide a current capacity for their panels to give us a Strategic Plan on recruitment and retainment efforts of their existing or remaining physicians so by the next board, i should have for you and overview of the physicians that have left the primary care that are there and what their capacity is to accept new patients and maintain their current panel. I just wanted to provide that quick update. How many was that . Fortyeight physicians, primary care. Fortyeight. So if members are in access plus, it doesnt really change things for them. They will move with sutter. They dont have to do anything. They can keep there dr. The doctor even after the change. There were about 48 trio members who sector is not part of the trio product, so those members, we have our Customer Service teams outreaching, even though they received a letter, the letter is kind of vague because it is mandated. We are doing outreach to those members to let them know that this has occurred and what their options are as well. In trio then they would no longer have their doctor. Yes. They would have to pick a new doctor to stay in trio. In and this is in the middle of the timing is suspect. At any rate, i wanted to make you aware of it. You will be hearing in the media that the new i. P. A. Is going to be formed by sutter in the city. We are doing our best to ensure that members understand their options. Even those that can move to the new centre i. P. A. , so they want to stay, they can, they just have to knew choose a new primary care. Any questions . Thank you. Any Public Comment on the item . Seeing none, item number 14. Item 14 is opportunity for the public to comment on matters within the boards jurisdiction. No Public Comment. Moving on to number 16. Item 15. Opportunity to place items at the boards jurisdiction on future agendas. Okay. I think we will have a full agenda for next meeting, too. No problems there. Any Public Comment on this item . All right. If there isnt any objections we have an objection. No, not an objection. I have a question. Go ahead. I saw there was no Financial Report in the boards agenda and i would like to know from our chief Financial Officer that we can say affirmatively that we are in good shape. I am chief Financial Officer. We are in good shape. The audit that is being done will not be issued before after the next meeting in and and what is holding it up is a lot of data that they need to have and they need to get the Enterprise Department that have bonds resting on getting their financials out. In terms of this fiscal year, there is no anomalies i see so i would affirm we are in good shape. Thank you. I just wanted to say on the record for this meeting. Yes. If that is if there is no objection, this meeting is adjourned