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 OfficerHealth 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 Healt