Secretary would you please call. Clerk thank you, president scott. Present. Commissioner brezlap. Commissioner freno. Excused and commissioner saff. Supervisor. Expected. We have a quorum. The chair thank you. I would like to ask the. Members of the board stand with me for a moment of silence for the passing of commissioner frignos mother during this recent period. So would you please. Thank you. We will now have action number 1. Check check item 1. Approval with possible modifications of the minutes of the meetings set forth bow low. Special closed session of january 11th. 2018. Regular meeting 2018. Randy scott are there any edits or changes regulated in the commission in the minutes of these two prior meetings . I do have a couple of edits i wish to bring forward. On page 5 of the minutes, it indicates that i indicated i had a duty to warm, warm. To introduce to the board. I would like to clarify that for the record that its a warm welcome and a duty and a privilege to introduce the incoming executive director. Also, as i did review the minutes, i failed to include recognition of the work that had been provided by the department of Human Resources during the executive directors search. And i particularly call out the fine coop rage we had fro cooperation from the director, Nicky Callahan and two members of her staff that were assigned to work with us. Christina brussa and shaunda akita. They provided a lot of staff and meetings and assisting the executive search firm during a various active ways during the process. I do thank them all for their hard work during that process. Also in the minutes, there is a section regarding the discussion of the doctors, and i would like to highlight that commissioner fallensby will be talking directly to the medical director of best doctors, and we are hoping that those meetings will happen prior to our march meeting at which time he will be able to report on that. So those are the items i would like to have noted. Lastly, i would like to have added to the minutes a timeline regarding the executive directors of the board. That was a piece that was shared by the commission paz we were doing the executive director search, identifying the key milestones of prior executive directors and i think it would be a useful documentation o or appendix to the section of the minutes when we are talking about the executive director search. And lastly, i would like to include the link or the actual bio we used for the director that was put on the sfhss website. So i would like that pinned. Clerk clerk i do. Rand with that, i would like to are there any other comments . Clerk we are adding thing to the minutes that randy scott well we did indeed discuss the announcement. The announcement was given on the date of the meeting. I and gave her a bik biography. Im asking that that document be included at that point. Clerk rules and order. Randy scott is there a motion to adopt the minutes . Clerk i have a motion to adopt the minutes. Randy scott this is our second. Its been properly moved and seconded. Is there any discussion . Any other discussion . We are now ready to [roll call] is there any Public Comment . Hearing and seeing no Public Comment, we are now ready to [roll call] all of those in favor signify by saying aye. calling of recorded vote carried. Item 2. Item 2. Discussion item on matters within the boards jurisdiction not appearing on todays agenda. Randy scott are there any Public Comments on any items that are not part of todays agenda . Hearing and seeing none we will now move into the rates and benefits portion of our meeting. As ive indicated on numerous occasions the board meets as a whole for the purses of rates and benefits so at this point we will take up item 3. Clerk initiation for the duration of the 2019 benefits process and actual wear request for proposal, acting executive director griggs. Mitchell griggs good afternoon, Board Members and to this time of year where we start out. Rates and benefits process. And part of that pro sets is now services and given notification to the board that we are entering that process. So we are doing so for 2019. In addition we are also issuing a request or proposal, rfp for actual Water Consulting services so when we do that we submit a blackout notice and i will explain to you what the blackout notice is, since this is an action item i will read out loud, the third and fourth packets of the memo. The a blackout period is a period of time from onset to the conclusion of a select process for a primary service provider. Where incommunication to Board Members and Service Providers seeking contracts with sfhss on matters related to sfhss cracking is excluded. Communiques includes outside the board or Committee Meetings or email and tax message, letter, faxes or uses of any other social media. Board members shall not communicate with Service Matters on matters expect during board or Committee Meetings. Board members who communicate with Service Providers for reasons unrelated to hss enclose such in writing to the director or the board. Unless you have any questions . Randy scott are there any questions from members of the board . Is there any Public Comment on this item . I move in a we adopt a blackout period. Randy scott is there a second . Second. Randy scott properly moved and sected that we adopt the blackout period as described in document attached to this meets minutes. Any questions from the board . Any Public Comment . Hearing and seeing no Public Comment. All of those in favor say aye. Eye. The motion carries unanimous i will. calling of recorded vote , i would like take this next item and move it to the Board Meeting if we may. If we pick up with discussion item 5. Yes, item 5. Review of city plans, 2017 claims experience. Good afternoon, im hewitt. Randy scott good a. Im here to present the 2017 review of the utilization and claim experience for the city plan for active employees and early retirees. Clerk we have a presentation. Thank you. So on the contents page we will start with summary of i will talk about today. Introduction and go into the specific experience for the city plan broken into the active employees and the early retirees. This is the first year we are not if h specifically reporting on claim experience for medicare retirees because 2017 was the first year that plan was fully ensured rather than self funded prior to that. So on page 1 on the summary, we will talk about the recent decisions to apply Stabilization Funds to the city planned subsidies and talk through the specifics of active employee and early retiree population experience. As noted the retiree is no longer captured in this presentation and talk about specific planned membership and contract size and average per cost per describer and average paid cost per describer. Where the difference is incurred is an the service state. So service state would have been incurred by the member during calendar 2017 and would have been claimed by 2017 regardless of the service state. So for the past several years, talk about the sustainability and i will have a full present taking on that shortly. The Health Service board has chosen to apply claims Stabilization Fund to subsidize the early employee and retiree rates. The conversion of the fund as i mentioned for the medicare funding to allow for land Stabilization Fund previously r allocated at that population to be utilized between the city plan and active employees and early retirees during the june 8th, 2017 meeting, the Health Service board approved the full allocation of stablation reserve as of december 31st, 2016 of 4 million, 529,000 to be 34r50eu to be applied toward the city plan for this year, 2018. One third of that was the normal allocation of policy. 1 million, 510 toward active employee and retiree group, and then the decision was made to allocate the remaining balance, 3 million and 19,000 for active employ subsidy. So we will refer to this when we balance our call cue layings on the existing state of the reserve. So on the next page, page 5, it shows a lot of numbers. A lot of detail. So let me describe what is here. So for each month during 2017, january through december, we capture in the first three columns the total number of describers. So these are the employees themselves. , that were enrolled in each of the three coverage tears. So the ee represents employee only. Ee plus 1, employee plus 1 dependent. Randy scott i think we have that. Perfect. So specifically we also show the number of dependents and the average contact size for each month. The rates for the plan are right across the next three columns which result when you multiply the describers by tier times the rates to the monthly premium. Compare them to the rate claims for each monday and the incurred claims for each month. We develop lots ratio which is the division of the claim amounts divided by the monthly premium. So ive highlighted and squared three specific observations which i will talk about on the following to the early population. This page captures enrollment in each of the three coverage tiers of the describers, and we have also segmented two groups of dependents and the head count for each month. The first where you see the column heading and the dependents of retirees. These are the nonmedicare dependents of nonmedicare retirees, averaging 174 for the year. We also have 230 on average, nonmedicare dependents of medicare retirees and their claims are also capture when we look at the total claim experience for the nonmedicare population. Randy scott alright. And on the following page we continue the evaluation by looking at what the total premium is. Separated by about 12. 3 million for the monthly premium in total for the year for nonmedicare describer tiers. And then we also do a calculation on the nonmedicare dependents of medicare retirerieretirees totaling 3. 3 million in premium. And then you can see the comparison to the paid claims and the incurred claims and the resulting loss ratios. So on page 10, similar to what we have seen with the active employees, we have seen growth in the total manitoba of retiree describers in the plan for nonmedicare. When we look at the average contract size which looks at the total dependents on nonmedicare dependents on the plan is a ratio of nonmedical describer, we have also seen growth on. That if we look at the average contract size only when comparing the nonmedicare dependents of nonmedicare retirees thats the 1. 23 i remember to on the prior pages. Randy scott alright. Im on page 12. Are you getting to the conclusions . So page 12, just to summarize the information ive walked through, we have seen an increase in membership in the active employee and retiree pools. The average cost per subscriber for early retirees did decrease since 2016 but increased for active employees. We continue to see high loss ratios for the active employees which does validate the application of the incremental city planned stabilization reserve monies for the active employs on the 2018 rating and we will present recommendations on the coming months. Thank you. Are there questions by the commissioner on this presentation . Any members of the commission . Is there any Public Comment . Hearing and seeing no Public Comment we will then move to the next item. Michael is going to stay where he is. And we will go on to action item 6. Clerk great. Thank you. Item 6, action item review the city plan Rate Stabilization reserve. Mike clark. Mike clark and hewitt. On the first page, page 2 of this document, i wanted to step back based on the conversation from last month and just outline that there are three Distinct Health plan reserve policies for the Health Service board. So there are three reserves for the selffunded health plan. So two i presented last month are the first two i list here. The imported reserve which is the unpaid claim liability for runout claims as of a certain date where services have occurred. Payments have not yet occurred. And we calculate that as of the end of the fiscal year, june 30th every year for the last plans. And we also calculate the reserve as of that date which is a determined amount that helps protect the trust and the plans from potential funding estimate shortfalls which could occur if actual claims occurred if a plan were to exceed projected claims when we develop our premium give lent. Randy scott thank you for reenforcing and responding to that request in this kind of context. Youre welcome. And the third is todays presentation. I will be presenting specifically for the city plan on the stabilization, the Rate Stabilization reserve. Which is an annual determination of financial gain or loss for the self funded plans, which we will go into more detail, and we calculate this as of december 31st so the end of the plan year. So there is a distinct versus the first two there. So i would like to ask question. The difference between the stabilization reserve and the contingency reserve. Now the stabilization reserve comes from the premiums being higher than the actual cost, is that correct . I would like to say higher or lower. Right you about the contingency reserve is money put away out of a trust just like the ir is ibnr is. Correct. Randy scott okay. So for todays discussion on page 3, the stabilization policy is for a gain or loss over the calendar year for the self funned plans. With that difference added to existing stabilization reserve balance and for policy amortized over a 3year waiting period. So on page 4, just as a timeline summary of what leads us to today, at this time last year, it was determined that the december 31st 2016 stabilization reserve for the city plan was 4 million, 529,000 available to stabilize rates. In may 2017, the board approved using one third of that or 1 million, 510,000 to buy down the 2018 active and early retiree premiums in the city plan which left 3 million and 19,000 in the research. The following month on june 2017, the board approved using the additional 3 million and 19,000 to buy down active premiums. So as of that period of time, the expectation was the entire december 2016 reserve, the Rate Stabilization reserve for the city plan would be applied to 201 rating. Theoretically leaving no funding for 2019 and beyond. So today i stand at the beginning of this rates and benefits cycle into the 2019 planned year to report on the claim experience for 2017, and based on that, 1,661,000 is available for stabilizing rates for 2019 and beyond. So page 5 presents a table that shows the difference between the expected flow of monies on the city plan, active employs and early retirees for 2017 relative to the actual flow of money. And there are footnotes that describe each of these elements and the pages that follow. Essentially we are looking at the claims and expense for the plan offset by Prescription Drug rebates. That total is compared to the totality of contributions received for the plan, a combination of the system and employees. And retirees to calculate the revenue either shortfall or surplus. In this case a short fall in both columns but less of a short fall than was originally anticipate when the rate were first developed for 2017. Per policy we also factor in the change in contingency reserve which in this case is a decrease to reserve of about 139,000. And so the difference between the expected revenue shortfall for 2017 of 7,586,000 and the actual deficit of 5,925,000 becomes the 1,661,000 available to stabilize in the future that i referred to earlier. Randy scott are there questions from the commissioners regarding that . Commissioner sass. Just to be clear. The shortfall was expected to be 7. 5 million and the actual was 6 million . Is this is that the short fall from which you use stabilization to balance . Or is this an additional short fall above and i dont know the overall stable sage w stabilization we use to balance . So the 7. 5 million was expected and that was at the end of december 31st, 2016. If i may i will attempt to answer your question. And direction to you page 8. And by all means if you have further questions, please let me know. Randy scott yes. Whereas we have the surplus carried forward as of 2016, we now based on 2017, experienced and adjusted an increase by 1 million and 61. So that would create a stabilization reserve at the end of 2017 of 690,000 but we applied 4,520,000 through the combination of the next two items, and therefore that is our suggestion that 1,661 is available for the city plan carried forward for 2019 rating. And then based on policy we would suggest one third apply to 2019 rates. 554,000. Of course your decisions on that will come when we present on rate recommendations in the coming months. And that would be in the may time frame . Correct. Randy scott questions from the commissioners regarding these calculations or the result at this point . So this is an action . Randy scott well this is a recommendation up to this point and it will be an action item. Just looking here its an action item. Randy scott its listed as an action item so are you asking us to adopt this recommendation . Yes. Randy scott they are asking us to adopt the recommendation listed on page 8. Can i ask one more question . Randy scott commissioner sass. Clearly the small rate will have a small impact on rates because rates were high in the year that we are currently in, but with the benefit of a 4. 5 million stabilization amount. And it appears that even with growing enrollment, even if we have growing enrollment we just have growing losses and lamper deficits and that appears to be the trend over the last couple of years. A 500,000 stabilization amount will result in extremely high rates, in any view. In fact, if the spire a. M. Were used it would still have a very small impact on rates. Because its less than half of what we used for stabilization a year ago. Should we do Something Like that dishes want to be clear on the implications on this, if we will come back with a recommendation later. If we use all of the stabilization money and we continue to incur losses that