Transcripts For SFGTV Health Service Board 20240712 : compar

Fourstep process for the dental plans to determine the needed rate change factor in this case from 2020 to 2021. Next slide. So with that, well review ratings summary for the plan that well review today. Next slide. Next item, please. The covered populations for the sfhss dental plans as well as the member contributions are outlined on this page. The active employees of three employers are offered dental coverage throughout sfhss, and those are the city and county of San Francisco, the superior court, and the municipal executive employees. For the ccsf, ccsfmea, and meamta employees, they pay 10 a month for single tier and 15 a month for family tier in the p. P. O. These employees pay no contributions for the two dental h. M. O. S that are offered. The superior court and superior court m. E. A. Employees pay no contributions for dental coverage, and the active employees of the San Francisco Unified School District and city college of San Francisco do not elect to provide dental through sfhss, so their dental occurs outside of sfhss. And all of those employees participating are offered dental plan coverage in retierr retirement, and retirees pay the full cost of each employer dental plan with no employer contribution. Next slide. This page illustrates the renewal action summary that ill be presenting today for recommended Health Service board action. Weve focused on, for 2021 plan year, understanding how plan costs in 2019 are impacting 2021 rating actions, and youll see the summary of changed recommendations along with the total enrolled employee and retiree members in each of the programs offered for dental through sfhss. Youll see only one plan is proposed for a rate change action plan increase, and that is the employee action p. P. O. With a modest 0. 6 increase. All other plans are proposed for a decrease due to the elimination of the federal Affordable Care act Health Insurer tax into the 2021 pay year. Next slide. This page illustrates the total cost rates on a monthly basis for 2021 across the active employees in the first three columns of this illustration and the retirees in the last three columns of the illustration. With the delta dental p. P. O. In the top set of figures, the midd middle p. P. O. In the middle set of figures, and the delta h. M. O. In the lower set of figures. So todays recommendations that ill cover shortly are the 0. 6 increase in total cost increase in the delta dental care p. P. O. , a 3 decrease for the United Health care dental h. M. O. Plan, and the [inaudible] retiree p. P. O. Next slide. So with that, well go into the active employee p. P. O. Fees and rates. Next slide. Again, 0. 6 is the recommended change in rates from 2020 to 2021. This incorporates favorable rate change as well as one half of the existing Rate Stabilization balance as was approved by the Health Service board in the may 4, 2020 meeting, and the recommendation includes a new recommended nitrous oxide and noni. V. Sedation benefit to support members during dental procedures which is expected to add 126,000 in aggregate claim dollars for 2021 or 0. 3 which would be funded by the members in premiums or fixed dollar amounts. This is a slide that we reviewed earlier in previous meetings to look at the experience of the dental plan, both in 2019 and over the course of time, and you can see that the loss ratios have been favorable. 100 in 2019, and the per employee per month claim and fee cost has been relatively constant each of the past six to seven years at 120. Next slide. The administrative fees are under a rate guarantee, with 2021 being the third year of that rate guarantee for delta dental of california. You can see the history of the administrative fees on this slide, most notably 4. 62 for employee per month will continue to be the ad stiff fee into the 2021 plan year for the delta dental p. P. O. Next slide. And so this illustrates our calculations that lead to the 0. 6 increase in premium rates for 2020 to 2021, which includes one half of the rating buydown application and the addition of the nitrous oxide nonsedation coverage for the active employee p. P. O. The claims are used from january 18 to december 2019 to generate these rates with a 2 annual trend assumption, projected to 2021. And so our recommended 2021 selfinsured rates for on a monthly basis are 57 consid 57 employee only [inaudible] next slide. So now, well transition into conversation on the fully ininsuri insured dental plans. Five fully insured plans are provided for h. M. O. Plans and all for the active retiries, and because of the removal of the Affordable Health Care Insurance tax result in decreases. You can see it results in a 5 for delta dental, and a 3 reduction in uhchmo. So this results in the delta dental care rates transitioning from 2020 to 2021 for the active employees on the top part of the table and the retirees at the bottom part of the page. Next slide. We present a similar exhibit for United Health care dental h. M. O. , where you see the rates decrease by 3 from 2020 to 2021, with active employees at the top of the page, active retirees at the bottom. Next slide. And for the retiree p. P. O. , delta dental has agreed to add the nitrous oxide and noni. V. Sedation benefit described earlier for the active employee p. P. O. At no additional plan premium to the retirees. And so the 1. 75 reduction due to the elimination of the federal Affordable Care insurance federal tax will hold, and no additional premium is being added into the eat for the nice russ oxide and noni. V. Sedation benefit addition. Next slide. So with that, ill recap our recommendations for Health Service board action today. Number one, for the delta dental active employee p. P. O. , recommend acceptance of the p. P. O. Rates represented in this document, to the total premium rates, which include the provision for the added nitrous oxide and noni. V. Sedation benefit, as well as the holding of the 2020 administrative fees for the 2021 plan year, and then, tot the insured dental plans, accepting the rate renewals as presented in this document, which includes the provision for added nitrous oxide and noni. V. Sedation coverage being provided to the retiree. And with that, transition to the next slide and ask for a statement from the delta dental representatives. Do we have a delta dental representative on the line . Clerk mike, i dont see her name on the list, but im looking right now. Give me one second. Let me reach out to her directly. Give me one second. Commissioner zvanski this is commissioner zvanski. Mike, do we have representatives from the other plans who will be speaking or just delta . There are representatives from the other plans that will be available. Were not going to do this request for statement, but the representatives are available from the other plans as i do those presentations for any questions that are best answered by the plans. Commissioner zvanski thank you. Natalie, we can move on, if youd like, to commissioner comments and questions. Clerk yes. We can move onto commissioner comments and questions, and i will continue to reach out to her directly. Great. So can we go to the next slide . Thank you. President breslin . President breslin okay. Are there any questions from the Board Members . Vice president follansbee yeah, this is commissioner follansbee. I just want to make sure that im clear, that the only benefit change in these four requested actions or in the delta dental active employee for the nitrous oxide and noni. V. Sedation coverage, is that true. And also for the retiree, as well. The addition of nitrous objection item and the noni. V. Sedation coverage for the active employee and retiree p. P. O. Are the only changes to the policies. Vice president follansbee this is commissioner followans b follansbee. I do have a little bit of concern in older individuals. As far as the sedative is benzodiazepines, and im concerned if the study included some sort of observation on discharge from the practice because i do want to make sure that the benefits that we approve are, indeed, applied safely to all of our members. And again, older members may be on medications that may enhance the effects of noni. V. Sedation, but they may also be true of the delta dental, to active employees, as well. Id just like to hear from delta dental about that. If i may, dr. Follansbee, this benefit or these procedures are being done now. They were not being paid for, so your questions on the sedation and the safety protocols in place are valid, and im sure that they can be validated. In the terms of the dental benefit, there are people that wont go to the dentist unless they get nitrous oxide or some sort of sedation, so it was looked at from that lens, but we do want to assure that it is being practiced safely. Vice president follansbee can i just maybe have some clarification. Before we covered this, were members being billed additionally, then, for nitrous oxide and noni. V. Sedation . Yes. Vice president follansbee i appreciate this may be something thats already in process. It adds a certain element of risk now to us as a Health Service system if we are now covering this to know that those procedures are now in place. True, and yes, theres many examples of that. I dont know if theres any liability. That would be sort of a legal question, but yes, i mean, we always would look to a best practice and standard practices for these types of procedures. Commissioner scott this is commissioner scott. I have a question for mike. Has the preventative side of our benefits utilization increased, stayed the same year over year . Can you give me your impression of that, mike . Certainly. It actually has improved somewhat, so in the last year, comparing statistics we received from delta dental specific to sfhss employees and retirees on an aggregated basis, we did see a decrease by 0. 5 on the active employees, and 0. 7 on the retirees on the overall percentage of covered members who are accessing at least one covered service during the course of a year. President breslin i would add to that that delta dental, we have been working with them to do more aggressive campaigning about utilization of the dental benefit, and they were working toward that when this covid hit. And so obviously, thats been put on hold for the time being. And we did include, in the directors report, a utilization summary over the last number of years, so we do continuously look at that with del delta. Commissioner scott yeah. I was just going to make one last small additional comment. Delta dental gives us their book of data, and it is higher among sfhss active employees than it is for book of business. Commissioner zvanski this is commissioner zvanski. Its been a long, long time since i sat in on those negotiations to get the dental plan. I thought at one point both unified and Community College merged their active dental with ours from Health Service, and im just wondering when they split off because we usually say to the School District, if you take your actives, you take your retirees with you, and i notice that we are covering both School District retirees, and theyve apparently gone 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