Theatres their high energy and a lot of positive energy it happens that sf i u are our largest classification of over one thousand staff maybe we can do a Pilot Project i think thats something we modesty be able to do soon to fight the bureaucracy thats where were headed to see if we cant streamline this. I made a presentation at the jc c if you have any questions, ill be happy to answer them. Questions yes commissioners he promised 90 days so commissioner. I worry about i had information of the people who were hired at the same time people left. The turnover is 10 percent so roughly close. So question. The other question is why was the did we stop the rule of the list for hiring because the state department of personnel came in and did an audit of municipalities and said since youre getting state funding we want to make sure your youre going the merit processes and they pointed at the list thats where youre giving our manager a great list and not distinguishing between two and three. The rule of the list requires you to hire one of the top two or three people. We give you a giant list the way they want is the rule of 3 or 10, in fact, the s c i u agreed to a list of 12 classics theyll let us do the rule of strength its good. The last thing i know in the city weve had very little in the form of aside from people being promoted through the merit system theres very this incentives that have been put in place for good employees to be revoked throughout and im wondering if were doing anything between the department of Public Health department to prevent people from leaving we spend money on them by training them it would be great to figure out a way to keep them. Were working with the director and, of course, the recognition of length of service and those with regards when you do the with regards once a year were doing more of that. We formed a committee jonathan and the Workforce Development committee and that might be looking at the recognition. We can look at that okay. Thanks. Further comments from commissions. We thank you for your no day analysis and look forward to hearing the results of moving the abate out of bureaucracy. All right. Ill be back. Thank you. I note theres no request for Public Comment. We move to item 11 any other bus. Commissioners any other business you want to bring to us if not well go on. The next item is the joint Office Convention committee and they didnt meet. Oh, yes, sir. The committee on march 11 is that okay. The quality measure update and i and more importantly from our standpoint we got an update on the joint surveys the response from the hospital and more importantly letters from c. M. S. And said they accepted the program and were no longer on their watch list and there will be no more monitoring so we can continue to take care of our federally funded patients. They accepted the corrected plan both plans were rectified chauflly with the committee and that joint commission has also accepted that as a corrective action plan theyll continue to monitor normally so well be maintaining our accreditation through the period of time to were expecting is on site accreditation survey that is our normal survey cycle of every 3 years at sometime during this year i dont know if my colleague has anything to add and in our closed session we approved our criminals commissioner sanchez anything to add. Many questions from commissioners. If not well go on ill note we didnt receive any Public Comment on that item and the item 13 is the Committee Agenda setting. Okay. The only setting we have right now is well look at the Committee Assignments and hope everybody will like to continue to work within the areas theyre interested in and also have developed an expertise. Well ask that you respond to mark so we can looked at that in the next several weeks to have assignments for our staff to work with in the coming month. Okay. So i appreciate your response to that. Is there any Public Comment on that no. Theres no Public Comment. Okay. So were at the last item and adjournment is item 14 is there a motion for adjournment all in favor. I. Any nays . Were adjourned wow, are the beetles here or are we just reoping the playground . Im not sure which. Thanks to the 2008 parks funds, where youre standing is the home and all of you San Francisco voters gave a 20 Million Investment in this neighborhood. I was born and raised four blocks from where we stand today. I came and played in this park, on the equipment, in the you know what i mean you know jim gym and structure today. To make this a park that everybody can enjoy, a diversity that would show the city that this is what San Francisco is all about. What we got here is 3,000 new square feet of places for people to be healthy and be active and the community to gather. If you see kaellys mural in the building, there cannot be an imagery thats more related to this place. What people told us about what the importance of the windmills and the green houses and the flowers that used to be grown here and the wind, lets not forget the wind. We have to continue to invest in our citys infrastructure and creating new. This is a Recreation Center for the 21st century and for the 21st century communities. We finally made something after somebody that Everybody Needs and this is the park. The Health ServicesBoard Meeting will now come to order. Please stand for the pledge. I pledge allegiance to the flag of the United States of america and to the republic for which it stands, one nation, under god, indivisible, with liberty and justice for all. Madam secretary. Item no. 1, please. Roll call . Sorry. Roll call. Vicepresident , supervisor ferrel, commissioner expected, commissioner fraser, commissioner scott, excused. Commissioner swain, expected. We have a quorum. All right. Item no. 1. Action item. Approval of the meeting set forth below regular meeting of february 13, 2014. All right. Are there any corrections to the minutes . No corrections. Move. Second. Its been moved and seconded. Any Public Comment on this item . All in favor say, aye. Aye. Opposed . Its unanimous. Now well go into the section. Commissioner scott is not here today today. Our first item is action no. 2. City clerk item 2. Action item. Preservation amount. Good afternoon, my name is gabriel brigs and as you are all aware every year the survey is done where we survey the 10 most populus counties in california other than the city and county of San Francisco and what the union and employees contributions are and take the average for each county and period of time charter, the city contributes that dollar amount of health care to the city employees. Information gathered from the survey, 10 county survey, we go online and get all the information we can from the counties including the benefit designs. Today we will be reviewing that. Is there any way we can put it on all right. Just the highlights of this, please. All right. On page 2 you will see that the average Monthly Contribution for the 2015 plan year is 567. 80 cents. That is higher than last month. You will see that 1. 46 is lower than historically it has been increased by and there is a few Different Reasons for that. There are a few counties that have made changes to what they are offering to their employees. For example, sacramento county, they took way all the plans except for the kaiser plans they were offering and now they are offering new plans and lower cost plans, high deductible plans and their employer contribution went down significantly. There are various other counties that behaved as we would expect that had high increases, but there were a few counties and we can go through a few of them if the board would like that contributed to this low increase. Ask the opinion of any board member. Would you like to go through it . I dont need to. I read the chart. Okay. So are there any questions . You use d the same methodology . The methodology is on page 2. I believe this is the lowest that i have ever seen since i have been on the board. I was ask petitioner if she would agree to that. I noticed that pers had a quite low pay for pharmacy. They are stuck with the generic with 5 across the board. Those are the things that i noticed. Santa clara county had also the same for local. Are there any questions . Dr. Gopey . I just wanted to point out that when hhs and the board supported the 9383 contribution model for last year, it was because we were concerned about the volt tilt in the county. We had already seen that Fresno County had a flat contribution and we were hearing the countys talk about limiting the contributions there. So, the volatility in the county is something we have been concerned about and i think we remain concerned about this is the sign of things to come and more counties are looking at limiting the employer contributions around that. So, more, i think we were asked last year, the Health Services to look at the counties carefully to see if there is anything else we can do, but i think its reflecting the environment in the marketplace right now. Any other comments . This is an action item. We need a motion. So moved. Second. Okay. The motion is to approve the 10 county survey. Its been moved and seconded. Any Public Comment on this item . Speaking of the former commissioner, i just, you are right, we havent seen these kinds of low contributions for a while. In the mid90s we did. There was a shift and it was fresno and riverside that brought us down. There was one point where riverside entered as one of the 10 counties where previously it had been in a different county. We have only seen this trend in the last 10 years. It maybe a cycle that it goes through. It had to do with collective bargaining and a number of other issues in population. Fresno is one county to watch more than riverside. They brought the 10 county matt down several times over the last few years. Thank you. Thank you. Any other Public Comment . Seeing none, all in favor say, aye. Aye. All opposed . Its unanimous. Item no. 3. City clerk item 3. Action item approving of action plan continuing fee proposal. On hewitt you have before you a presentation last year as part of the rating cycle we went through a laborious settle calculations and now we are under a 2year rate. The rates are posted on page 1. The e plus 2 is 11. 30. And as a matter of being complete. We wanted to let you know that you do offer the vision care benefit for people who need computer assistive glasses and cost 0. 85 per employee per month. We also wanted to raise on page two of this document that we at that time determine is reasonable and sufficient for premium yuns and you are under a rate and we bring the rate as part of the cycle of this business. Do you have to approve them . I dont know. I will to have ask eric about them. I think we need to reapprove . You have a 2year . Im trying to think back a year ago did we approve a 2year rate renewal. It might be best. Its not going to hurt. Okay. I need a motion. So moved. Second. Okay. Its been moved and seconded to approve the vsps 2015 proposal. Any Public Comment . Dennis krueger, active and retired firefighters. I was under the impression this year they were going to offer a 2tier plan. They had discussed it before, but i see nothing in this proposal that accounts for that. Thank you. Thats a good question. The system can now handle it. It will just take us about 6 months of work to rebuild the system to be able to administer this. So currently, the vision benefit and the medical benefit are being administered together. The eligibility files are combined and the programming is combined. To split that out it will be a much bigger effort than we initially understood. It is in interest of ours to do that. We have clean up with the basic administration that we are working on and we are hoping to still bring that offer in the future. At this point i cant tell you exactly when it maybe for 15, it maybe for 16. So there is still a possibility it be offered in 15, but most likely later on. Im sorry, open enrollment 15, but plan year 16. Thank you. Any other Public Comment . All right. All in favor say, aye. Aye. Opposed . No opposition. Its unanimous. Item no. 4. City clerk item 4, action item consideration of city plan stop Loss Coverage for 2015 plan year. An hewitt. So just as a matter of historical to revisit to what happened last year, we presented some stop loss options and the board voted to not stop loss insurance because it wasnt necessary and it wasnt, the premiums were going to cost more than the expected rebates. So, on slide 2 we have an overview of what stop loss is. Unless there is any questions about that, im just going to skip to the actual quotes. There were four quotes that United Health care has provided. Two of the quotes are for actives, early retirees and medicare. Whereas the second care is for actives and early retirees. The table on slide 3, shows the quotes, the contract terms would be for, so paid 12 means that anything that was incurred ever since at the beginning of the contract would be covered as long as it was paid in 2015. Thats a contract term. You will see that for an individual deductible 500,000, it would cost 26. 90 per month. A duct eductible for 1 million it would cost per month for a thousand dollar deductible. On slide 5 we done some analysis. We took the large experience that the city plan experience from july 2012june 2013 and we took the claims and we trended them forward by 7 percent a year. We have calculated that with the 500,000 deductible, the rebates would be approximately 908,000. If you turn back to slide three on the table, you will see that for alternatives 1 and 3 which are at the 500,000 deductible, the premium is well beyond with the expected rebates would be. If the deductible were at a Million Dollars, our estimates show there would be no reimbursement whatsoever. Ian hewitts recommendation is to not ensure stop loss. There is a reserve of 16 million reviewed at the last meeting. In case there were catastrophic claims there is a contingency reserve to be used. Even then we dont believe it would be necessary. Thank you. Any comments . Can i have a motion . So moved that we not purchase it. Second. Seconded that we do not purchase stop loss insurance for United Health care. Any Public Comment on this item . All in favor say, aye. Aye. All those opposed . Its unanimous. Now, item no. 5. Discussion item. City clerk item 5, discussion item, review blue shield nonmedical claims experience benefits designed and determine preliminary contribution for 2015 plan year. Ian hewitt. You may have an substitute tab for tab 5. Thank you. Okay. Before you you have the presentation on tab 5 as blue shield. So we reviewed the experience. This is the third year flex funded. It behoves us to share with you how it did do and we take the risk and you obviously want to know did we come under or over or did we generate all the reserves we need and the contingency reserve and how the numbers are looking. In addition to giving you a flavor to what will conclude in june, is how did it do. As a matter of refreshing, we revisit on page 2 and 3. Whats at risk, what are you paying for, those kinds of things. Under those flex funded as all of you know for the audience and everybody who is listening, you pay straight fees for Administration Charges in capitation it outlines here what is covered under capitation. Therefore, those kinds of thing are paid on a fixed age adjusted basis. Whether you are at risk, a deeper exposure a volume for claims whether you are inpatient, and pharmacy claims then you pay your administrative and as we have discussed before you have various taxers, you have your reassurance and hit tax. You pay the full tax because this is an insured product. With that being the case, we will now visit on page 4 of the experience that happened on a paid and on an incurred basis for 2013 under the flex arrangement. Its a lot of data, so bear with me because i cant real it all. What you ended up collecting for the actives is 230 million which is under the monthly premium which is right there. Thats what was brought into the the trous to cover the claims and cost structure of the flex funded program for 2013. Your total expenses on a paid basis were 203 million. So you have on a paid basis 88 percent loss ratio which turnout to be just fine. Certain thing i want to point out is if you look at the total expense for total paid expense for january and february, more january, we explained when we went through this process that for that month, the insured contract would pay the claims that were incurred december 12th and before and so we would expect to see less paid, literal paid claims but you would have to take the difference in that in the premium and bank that in your reserve. With that being said. You had at 88 percent and in the far column what we did was shared that you needed 18 million, 18 1 2 Million Dollars in reserve for funded. We added 18 million to the paid claims and that is a ratio of 95 percent. Are there any questions for the way it turned out . It turned out just fine. What did i say . For actives. Sorry. Can you back up for one second. Can you ream remind me and i apologize me. We are at risk for the hospitalizations, we are at 4 for specialty physicians so you n