Back to their active benefit which i have to say is a better benefit than what we were covering at first. Does anyone have any idea when that happened . Im just curious. Its something that we actually have been working with the School District over the last year, to consider taking over the dental benefit on their behalf. And weve asked that question and have not found anyone who knows the answer. So we can take this offline, but yeah, anyone that we spoke to, they could not document the history of how that got back to the School District. Commissioner zvanski okay. Well talk about that later. President breslin anyone else have anything else to say . I have a couple of questions. Okay. I dont see a page for the for the retiree h. M. O. Design elements. Theres one for the retiree p. P. O. Design elements and theres one for the h. M. O. Elements, but not for the retirees. I dont see that, the copays for the h. M. O. S. Am i missing something . Yes, i know there are appendix pages that have the design information, and we can certainly supply any additional design information. President breslin thats the only one thats missing, unless its the exact same as the actives. Yeah, let me follow up on that, and well follow up after the meeting. There were no design changes, though, karen, in this year. President breslin so the copays and all is what im looking at, and so everything is, like, 100 covered for the actives, but is it also for the retirees . Its a different plan design than the actives, and mike, i dont know if you can recall offhand the details. Yeah, im just stating that there were no changes this year to what was in place currently in place. Are you looking at page 28 . President breslin yeah. I have page 28 that gives the retirees. Am i not looking at the right thing . Yeah, anthony, if you could please go forward [inaudible] president breslin h. M. O. These are the h. M. O. S im talking about, not delta dental. Got it. Sorry. Okay. Well follow up after the meeting. President breslin yeah, im just curious when comparing the two. And i was also curious about the nitrous oxide. I called my desk about it, and they dont use any sedation at all there. They dont do it in their office, and theyre i consider them top line dentists. Nitrous oxide, they do. They charge 40 at the moment for that, and i dont know any much else. Are there a lot of members that are asking for this sort of thing that you know of . We dont have a count on that. President breslin so the 0. 6 for active, does that include active predicted for this benefit next year . Is that part of their 0. 6 increase . Correct. So it would be a 0. 3 increase without this added coverage, and then, a 0. 6 that includes the added coverage. President breslin should have probably had a second scenario on that, i think. So was this delta dentals suggestion . It was a proposal that they offered upon us asking if these coverages were possible to be added to the program. President breslin because if you now have a very small usage of this program, it just means more money for delta dental. Thats why im curious what the usage would be here . Is it just going to go into the pockets of the delta dental or is it really going to be helpful to the members . Yeah, and thats where [inaudible] yeah, and to the degree that people are going to the dentist that have this covered benefit, that will help. President breslin thats a yeah, its a tough population to kind of get them to change their behavior to go to the dentist. Theres just people that are very reluctant to go. Commissioner zvanski through the chair, this is commissioner zvanski. In my experience over the years, both when i was still active, since ive been retired, ive heard from many, many members who use the nitrous oxide option and wish that it was covered, but i know that theres a fairly at least the people i know, and maybe thats a specific group who commented on the fact that nitrous oxide is what they needed because they had such high anxiety when they went to the dentist. I have to ask dr. Follansbee, the active prescription, when they go to the dentist, do you know what that might be . Vice president follansbee i can speculate that its not a drug like diazepam or valium, which has a very, very low short life. Its probably a benzodiazepam thats short acting. Most of the time, this is a prescription medication, but a short acting one is what i would assume, that that was part of the general sis of my question to delta dental. There you are. We hear you now, sharon. Sorry. Im listening on my cell phone, and im hearing. And were hearing you. Oh, my gosh. Thank you. Im so sorry, everyone. So i would like to provide delta dentals comments at this point in time . Delta dental sincerely values our clients, and we understand the struggles that our patients and clients are experiencing at this time, which we have launched initiatives to support our patients and dentists. We do not intend to profit from this situation, and we will be announcing Additional Information in that regard later in june. Through ongoing discussions with sfhss leadership, as just what has been presented within the recommendation, we will not enhancing the benefits in 2021 to include nitrous oxide and noni. V. Sedation coverage to both the active and retiree p. P. O. Dental plan. This change will be done with no impact to retiree premiums. We continue to encourage all members to follow athome dental processes, such as brushing and flossing daily flo. On march 29, delta dental made an investment into helping those most affected by covid19. 3. 5 million will support increasing access to care across the foundations 15state area. The rest will be appointed to federally appointed Health Centers that provide primary Care Services in underserved areas. 1 million available to these organizations responding to the Public Health emergency and to members experiencing increases in costs and budget shortfalls as a result of the pandemic. 5 million will be focused to california organizations to those dealing with seniors, those living with food insecurities, those experiencing homelessness, and home bound individuals. And on april 15, delta dental of california announced a 200 million loan program through a partnership with lendeavor that will help organizations through 15 u. S. States and the district of columbia. Thank you. Vice president follansbee so this is commissioner follansbee. Thank you for that. I dont know if you heard some of the Board Members questions and conversation prior to your coming online. The question that i posed was the issue of noni. V. Sedation, which i understand is already being administered in monany o these offices with an extra charge imposed to the member, and i applaud the intent, which is to encourage our members to Seek Services they might be avoiding because of an anticipated pain or discomfort, but the question has to do with the protocols and what drugs are being utilized for for noni. V. Sedation and how theyre being monitored and then how the members being monitored after sedation before discharge from the practice. All very good questions, which i will take back and provide answers. Commissioner scott madam president , this is commissioner scott. Clerk karen, youll have to unmute. President breslin im muted. Go ahead. Commissioner scott with that, i recommend that we accept the presentations as outlined on page 32 of this presentation as made by our actuary. Commissioner hao this is commissioner hao. I second that. President breslin this is a comment that i didnt get to finish. All dentists are charging for p. P. E. , the protective equipment that they need to have now. Im not quite sure what the charge is, but i know theyre charging extra for that. And also, my observation is i think that the utilization would be down a great deal for 2020 because i know very few people that have been going to dentist unless its an emergency, so i would suspect the new use would be way down. There is an Additional Charge for the nitrous oxide for the actives, so that was my question, too. Some of these Additional Charges keep being added on for something, and i always think we should look closely at them to see how theyre being utilized. Are they necessary or is it just money going into the pockets of the provider . For instance, last year, the addition of 25 a premium or i guess it was a copay for a premium, our network people, in my opinion, just added another 25 to the to the delta dental because, yeah, this is under the guise of more people going to the p. P. O. , but my personal experience, i wouldnt be changing a dentist because its very difficult to find one youre happy with just for another 25, so i thought that type of thing was just kind of a scenario. So this is just my statement. Im not saying im not going to vote for this or something, but i do think we should look at these little additions that are thrown at us all the time to make sure that theyre good for the member. Okay. So theres a motion on the table. Its been moved and seconded. Is there any Public Comment on this item . Clerk thank you, president breslin. People who are waiting on the phone line, please press onezero to be added to the queue. If you have any comments, which is the dental rates presentation, were going to give a 30second pause, and then well begin Public Comment. Commissioner zvanski i have a question. This is commissioner zvanski. It looks like page 32 on the screen, its 24 when i printed it out. I followed every page, and they were exactly the same. I just wondered what happened. Am i the only one with a page 24 instead of 32, but its the same page. Clare, i can review that with you after the meeting if youre okay with that. Commissioner zvanski okay. That sounds good. Clerk moderator, will you please open up the phone line for the first caller . Operator you have one question remaining. Hello. My name is richard rossman, retiree, and im calling about the smile program, and i want to thank delta dental for the check they sent me for the confusion, and the letter. And also, i read in the directors report that the smile program is part of the 1250, although the smile program is supposed to be for prechbs tiff cleaning, so im not sure why its outside. But ill accept that, and on page my page numbers 28, where it says delta dental of california retirees p. P. O. Elements, and it says annual maximum, 1250 per person, excluding annual cleaning and exams, i think to make it more clear, delta dental should put a statement saying or a line saying that this the smile program is not part of the preventative cleaning and exams and its part of the 1250. I think that would go a long ways to ending the confusion. And then, the other thing is, on the flier they exhibsent ou where it says boost your benefits, they mentioned standard coverage, but most employees are on the p. P. O. , so they should put out another flier comparing the p. P. O. Benefits to the smile coverage, and i think this would go a long way to resolve this confusion, and thank you. Clerk thank you, mr. Rossman. Moderator, can you open up the phone lines for the next caller, please . Operator you have zero questions remaining. Clerk president breslin, that concludes Public Comment for this item. President breslin okay. We have a motion on the floor to review and approve 2021 dental plan rates and administrative fees. All those in favor, signify by saying aye. Are there any opposed . Its unanimous. All right. Item number 10, please. Clerk item 10 is the presentation of the 2021 medicare plan renewal summary. This is presented by mike clark from aon. Mike clarke, aon. This presentation previews what ill be walking through on each of the three detailed presentations that follow for the medicare retirees as well as the kaiser multiregion retirees for the 2021 plan year. Next side. So todays focus are the medicare retirees as well as the multiregion retiree h. M. O. S. Medicare has two programs that are available to us at sfhss, the medicare plans through kaiser, kpsa, as well as United Health care Medicare Advantage p. P. O. Program. And then, in addition to the kaiser Medicare Advantage program plan in california, there are also the multiregion plans in washington, the northwest, which is primarily the portland, oregon, area, and hawaii for nonmedicare retirees and medicare retirees. Next slide. With the prenom cannant focus the medicare plans, you can see the covered medicare lines in the uhcppo, which is available nationally, as well as the kpsa, thats available in california. Over 16,000 medicare lives in the uhcppo, and almost 13,500 lives in the kpsa, and with an additional 67 covered lives in the medicare plans in kaiser washington, northwest, and hawaii, totaling almost 37,000 covered lives in programs across sfhss. There are also 33 early retirees in the kaiser multiregion plans. So the remainder of this overview will focus on the kpsa offered in california and the uhcppo offered nationally. In 2017, sfhss navigated retirees to the two medicare plans available today. With the clinical and financial successes of the Medicare Advantage program over time, and continued enrollment growth that continues into today, both Political Parties generally support the m. A. Program with rate stablt, enhanced medicare education, and enhanced payment models in Medicare Advantage plans. Next slide. Clinically, the Medicare Advantage program is designed to support enrolled members through more effectively managing coordinating overall care delivery, providing targeted and timely care and complex case management, managing lengths of stay, including the goal to reintroduce readmission rates, more effectively supporting retiree end of life cost needs, and well talk at length about those for both plans today. Next slide. These plans operate at lower costs than original medicare due to direct subsidies provided to the Medicare Advantage health plans as calculated by the federal centers for medicare and medicaid. These subsidies generally increase from year to year. Because both sfhss medicare plans release next years plan rates before the final c. F. S. Subsidies are determined for the next plan year, there can be year to year rate change fluctuation in both of the Medicare Advantage plans offered by sfhss due to the fact that at present time those c. M. S. Subsidies are projected to best estimate but are not yet final. Next slide. This table illustrates how Medicare Advantage plans are structured to reduce costs and improve overall quality of care. Im not going to go through everything on this slide, but just focus on high level, the sources of those Cost Reduction and Quality Improvement initiatives on the left side starting with optimizing reimbursement to the plan, which helps to lower the cost that passes through after those federal subsidies to plan sponsors, like sfhss, with risk adjustments, and the star bonus programs, where higher stars represent higher revenue from c. M. S. Flow into the plans and thus lowering the rates that plan onto sfhss. Provider collaboration and building those provider relationships is another ski component of the Medicare Advantage program, and improving Member Health through care management, offering enhanced Preventative Care benefits relative to medicare, and a coordinated integration approach to care and benefits that addresses complex medical needs and end of life care for members. Employers committed to group a medicare retirees benefits should consider a managed care approach where we see at least a 10 reduction in care offerings due to care management. Next slide. In linking the goals of medicare plans and Medicare Advantage plans to the sfhss Strategic Plan, from an affordable and sustainable standpoint, these m. A. Plans offer the greatest ability for us at sfhss to sustain affordable plans for medicare members, reducing complexity and fragmentation. These medicare plans guide members and partnership with Patient Advocates within both programs to encourage Preventative Care and seek appropriate care alternatives when needs arise. The m. A. Plans allow for value added benefits that go beyond Core Health Plan coverage such as enhanced nutritional counseling, Fitness Programs, Transportation Services, and more that well discuss in each presentation that follows. Next slide. And for the last two Strategic Plan goals, choice in flexibility is a goal for the Medicare Advantage plans offered in northern california, with the local h. M. O. Model and the national uhcmappo program, and even those living out of the kpsa service areas, the United Service model meets the clients needs as a plan. The m. A. Plans are designed to support members across their spectrum of health needs through coordinated care when needing care. For more information on Medicare Advantage plans, we encourage you to review aons december 2018 presentation to the Health Service board, titled medicare managed marketplace overview, which is available on sfhss. Org. Next slide. So with all medicare plans being fully insured, the Rate Stabilization does not apply, and on a status quo renewal basis before any changes may be considered for 2021, youll see that the status quo rating actions are decreases for both plans into 2021 after both plans sustained sizeable inskraess in rates for increases in rates for the 2021 plan year. The presentations that follow will document the rationale behind