Range pretty significantly. On page 5, we did work with the cariers to understand more about where is the point of decision and how infertility is considered a diagnosis which is a requirement under the plan for treatment. So you can see here, outline of the three health plans to sum it up briefly. Blue shield and kaiser pretty much, their response indicates they leave the determination between the provider and the patients. Uhc relies on a medically necessary based on individual conditions. So again, pretty much pretty closely tied to that providerpatient relationship. In addition, on page 6, we did speak with page, who some of you may remember, who has worked with the Board Members in the past as a clinician who has very detailed familiarity with infertility from the clinical perspective. She provided some information on her perspective of what the current benefit looks like. She felt it was very comprehensive. She did note that environmentally, there is a shift from looking at infertility being the medical diagnosis to treatment of fertility. So that shift in mindset is happening in the environment and in the market place. And that Fertility Benefits so without the in, it can include prenatal, adoption and surrogacy. So fertility would remove the requirement for a diagnose of infertility. I think this last sentence on this bullet is important, though, and key to this mindset, is that certain Fertility Benefits have a tax consequence to them without that medical diagnosis. So that is something out there that were aware of and cognizant of as we have these conversations. President breslin a tax . Explain that . So, if there is not a medical diagnosis, the service isnt considered for pretax purposes under the health plan. So it becomes a taxable benefit to the employee. Or member. And thats a federal tax. Page 7. There are some Points Solutions out there. Some have been around a little bit longer than others and were seeing others pop up pretty much every day. Weve talked about all these new Point Solutions. There are three we have listed here. Just to give a little bit of information on three of the big key players that we see out there as were exploring others. Prodigy is an insurance car for reproductive services. And then a new player, carrots, is more of a reimbursement type program. The landscape is changing. Were keeping our eye on this. Talking to health plans. And talking to some of these other players to see what theyre doing and what is new and evolving in the market place. On page 8, so to get to the end. Preliminary findings in all of this various research ive just outlined for you, with the change to the benefits in 2017 and kind of removing some of those barriers to care, like the 12 months of unprotected sex that was previously required, we havent seen a significant change in the cost or number of members utilizing the inFertility Benefits. Total plan payment in terms of the pharmacy component of inFertility Benefits is trending downward. We believe that might be associated with some of the drugs becoming lower tier on formularies. The benefits landscape is evolving from infertility to fertility. And health plans report that physicians are relied on to determine the fertility and status. One question we had or we had wondered is are we reaching all the membership that we want to reach . And current Data Collection systems dont include Sexual Orientation or Partnership Status of those utilizing the service, which makes sense, but that was a question we had posed to make sure we are being comprehensive. As far as next steps, were going to continue to mine data through the database as well as with the carriers. We are with the goal of standardizing reporting as a result of this inquiry. Were researching carveout options to the Point Solutions and speaking with the carriers as well. We will continue to monitor market changes and trends that occur since those benefit enhancements occurred in 2017. We will compare evidencebased medically necessary and Fertility Benefits to elective options, so continuing to push ourselves to think about the concepts of infertility as well as fertility. And then investigating Third Party Administration for inFertility Benefits. So that concludes the presentation as far as the data that we looked at, preliminary findings, next steps. The last page has reference points. President breslin any questions. Just a comment. Im pleased that we have been this thorough in following up on this particular issue. We took a step in faith and it was not without some controversy at the time regarding, would there be a stampede of costs and all kinds of things were forecasted. But i think that we have done this in a very prudent way and in support of members. And this type of analysis will help to reinforce that Going Forward as we consider other medical plan changes that might be considered forwardleaning. That we dont just make a decision in the absence of any type of followup at all. So thank you for your work on this. Commissioner scott im curious if we have response or feedback from the members who utilized this service, in terms of their own impression of the services they received, compliments, complaints, or whatever. Per health plan. I know we have a member who has attended these hearings who i think is here today, who has spoken to us about her experience that wasnt the best. But outside of that, weve talked with Member Services and weve not had any other members call us to talk to us about their experience. We have considered, as we continue to mine the data on whether we will need to talk to any of our members, but we havent done that at this point. I wanted to acknowledge that a member of our team has worked very hard on this and is not able to be here today because shes attending training. But i wanted to acknowledge her work on this. You took the words out of my mouth. President breslin thank you. Any Public Comment on this item . Good afternoon, commissioners. Im a city employee. First i wanted to start by saying i feel heard and this is evident by the fact there is an agenda item and presentation before you today. So thank you. I also want to be clear. I continue to have concerns regarding the fertility coverage policy and how access is not equal across the board and harder for lesbians and those without partners to access. Simply as a point of reference, just yesterday, i received three denials in the mail. That i will have to fight an appeal, even though im still covered in the 90day window i fought for before and if i was in a heterosexual relationship none of this would be happening and i would be covered. The change in 2017 that added the qualify for service you needed to demonstrate a condition last month i shared a litany of things that didnt qualify for me. And the reference brings up its not showing this is the definition. It was listed as enhancement. I ask you to clarify as this specifically seems to exclude more people, particularly lesbians and those without a partner, if the definition removed one, you found a workaround, but not a workaround for the other. There was almost no quantitative data in the presentation. Basic data points, such as how many denials and for what reasons were not shared. Since ive spoken publicly on this, now three times and making pretty serious allegations, if data was shared with hhs that could prove my experience was unique or isolated, wouldnt it have been shared . Is it fair to draw the conclusion that there are employees who dont have equal access. Or that providers have not given the data requested. You asked for information and the providers came up here and said they would get back to you. Have they . Although this is not strictly an lgbtq issue, i want to remember you that june is pride. I raised this concern with hhs in december which means providers have had six months to get the Department Quantitative data. As a body whose sworn duty is to if this basic principle can be not be verified, it is within your power to act. It is within your power to define benefits that are within compliance and ensure equal access. It is within your power to rescind the vote and not move forward with the contracts until you are confident that every member has equal access to benefits. Thank you for your time. President breslin thank you. Any other comment on this item . Commissioner scott can i ask a question . There are compelling points being made. I wonder if we have commissioner follansbee if we have a mechanism to collect information on denials and reason for denial and have those reviewed, maybe independently. I mean, i think that, you know, its great to have, you know, the numerator in terms of how much money weve spent, but we are missing, i think, a lot of data. And i would ask for more information, particularly around the issue around denials of service. And whether that is health plan specific or across the board or what . I can ask the health plans to respond and what theyre able to produce on denial. On the other data, we do have a lot of data at this point and what we dont yet have is a good standardized way for how were going to look at it. Cdc does have report on fertility data, but some of the questions that are on the table are not yet answerable. We do need more time to do the analysis of the data that we have, because we have at this point more questions than we do answers. So it does take time to do the data analysis. And what were discovering is that there is no standard way to report this, so when we put in all the when weve asked the plans with the expertise of page through aon, we got the list of codes that were all looking at, but some of those codes made the people who were accessing them may be using some of the procedures are not necessarily infertility related. So there is all kinds of data questions we have. Commissioner follansbee i think the issue is, if were not necessarily tying the benefit to infertility and there is no medical code, it makes it even more challenging and its incumbent upon us to find a way. The question is, based on your sense of how things are moving, can you give us a timeline for when we can expect for information . Were thinking were be back in august. We are marching forward on this. Weve had two or three Conference Calls in just the last month since last month on working on identifying this. So thats our thought. And then if there was and one of the things, there is a whole lot of parallel tracks here going on. And figuring out if there is a need to consider the art as an added benefit. That is why were starting to talk to these third parties, because that may be something we need assistance, assisting the member in tracking the payments, especially if its determined its a taxable benefit. So there is big policy issues that we need to take a look at. You know, and again, i think its given the fact that the benefit was just put into place in 2017, were doing the first lookback at that benefit. I mean, maybe should have done it before, but thats kind of what were doing, were kind of inventing the wheel, there doesnt seem to be a standard report out there. Even our i. B. M. Folks have helped take a look, but we have a lot of questions. President breslin any other Public Comment . Public comment is closed on this item. We go to the rates and benefits section. Item number 11. Item 11, review revised rates and benefits calendar as of may 28, 2019, presented by abbie yant, executive director. Thank you. Your rates and benefit calendar is coming to a close. After todays meeting, we will go fill in the few blanks left on the rates package that will be introduced to the board of supervisors on june 18. Next tuesday. So weve got a short turnaround this time, but thats just the way the calendar crumbles. President breslin any Public Comment on this item . Seeing none. Item number 12. Item 12, review and approve the Hartford Life and disability insured rate renewal, presented by mike clark from aon. Good afternoon, mike clark, aon. Im here to present the Hartford Life insurance and longterm disability insured rate renewal which will cover plan years 2020 through 2022. Page 1, the insurances that well talk about today, basic Life Insurance, which is paid by the participating employers. Longterm disability or ltb insurance which is paid by the participating employers and memberpaid insurances for supplemental Life Insurance for employees and dependents, accidental death and dismemberment insurance as well. And then well present our overall renewal summary. I will note, i wont go through it for you today, but there is information on a program called the Hartford Life essentials that are Valueadded Services available to members, so i do encourage everyone to leverage the information in the appendix to learn about the programs available to members through the hartford. So recommendation summary on page 2 is recommending acceptance of the hartfords renewal for these insurances. Youll see the proposed rating actions illustrated below. Well talk through the rationale on the basic Life Insurance increase, but also noting that overall, insurance rates in total will decline by 12 relative to what is in place today for the threeyear period, 2017 to 2019. And this includes aggregate reduction in insurance rates for both the employers and members. Background on page 3. The Life Insurance and Disability Programs are available to certain active employees within the city county of San Francisco superior court, municipal executive populations. The basic Life Insurance, the l. T. D. And the supplemental life. The School District and city colleges are not part of the program. They secure the insurances through other means. And also the note that these insurances are for active employees only. Well talk about in this packet is not available to retirees. Page 4, the premium guarantee has been in place for the last three years with renewal that was approved under aetna. The hartford purchased aetnas group life and disability business in late 2017. So this renewal information is now underwritten by the hartford that were looking at today. But obviously, there has been careful transition as the hartford has looked to integrate the aetna group Life Insurance business. And that premium guarantee under aetna has continued through 2019 under the hartford. So on page 5, just one thing to note here. Again, through your renewal and the plan features will migrate as of january 1, 2020. So even though aetna has acquired the business, the contractual standards have maintained and will maintain through the end of 2019. Much of what the hartford has for contractual standards does match or exceed compared to aetna standards or with Something LikeLife Insurance eligibility, when someone leaves an employer covered by these insurances, they have the ability to, what is called port or basically convert the insurance into individual insurance at a set of specified rates. The aetna eligibility provisions are more robust than the hartford provisions, but the hartford is going through state insurance filings to match the aetna standards and theyre looking to accomplish that. I talked about the program that will expand and that is documented in the appendix. Ill start to talk about basic Life Insurance on page 6. This is fully employer funded. Most employees who participate are at the 50,000 benefit level, but there are four Different Levels of benefit, depending on the employee. And the proposed Life Insurance premium is projected to increase from 8 cents monthly premium per 1,000 of coverage, to 11. 4 cents effective 2020 through 2022. The rationale behind this is simply with the Life Insurance coverage over the past five years, looking at a fairly long period from 2014 to 2018, there have been substantially more claim payments made through basic Life Insurance than the premiums collected by the hartford. And so, there are other aspects of the rates that include reserves for things like waiver of premium. So if youre on longterm disability, you have your premiums waived for Life Insurance, and then incurred and not reported, reserves as well. All of those elements factor into the recommendation to increase the basic Life Insurance rates. I will say that in working with the hartford, and certainly were looking to achieve longer term stability financially on this plan, but part of your discussions with the hartford, they gave us a deeper reduction on longterm disability rates in return for somewhat of an increase on Life Insurance and overall that combination will actually benefit the employers. Employers will pay less in premium in 2020 for the combination of basic Life Insurance and Employer Paid l. T. D. Insurance than what would have been paid under the hartford initial renewal proposal. Then i have a chart on page 7 that shows the number of deaths that have claims that have been incurred in the basic Life Insurance program for each year, 2014 through 2018. Relative to a benchmark that was provided by the hartford for population similar in nature. Demographically and industry, that covered population. Can you pause there for a moment, just to clarify what they mean, similar . Are these publ