Start re auditing the population, a third of the population at a time. We want to go ahead and work on our rules to be able to do so. The language that we have added, audits may require submission of documentation that substantiates and confirms the dependence relationship, with the employee, or retirees current. Documentation may include, but not limited to current federal tax returns, and other documentation that demonstrates cohabitation or financial interdependency. This language developed based on industry standards. Other Public Sector amenities, and some of the other Retirement Systems that do the same thing. It is very common language, and a common ask that may be asked during a potential audit. We also worked with the City Attorneys Office to make sure that the language was good. The other change, for 2020, is what we do every year. We just update the document to say, these are our coverage. So for that plan year. That is on appendix a. Is basically coinciding with the payroll. And then once a month for retirees. Those of the changes we have made for the 2020 membership rules. Any questions . The first sentence in there, on paragraph e, does that include e benefits going through open enrollment, or you make your changes online . The way it is written in their is not. Notification would be somebody sending in a form to us, or going to selfservice, removing that dependent, as enrolled in their benefit. That is the notification we are talking about. [inaudible] open enrollment is also notification. It may not be timely notification. But currently, it is notification. We can state that notification is through enrollment of selfservice or through h. S. S. During the year, we need to remove a dependent, but you do it online, through electronic, but the word in the first sentence, i just want to understand that includes the electronic format. We can update that for 2021, two. Also. Based on the hard, and the learning curve, when we do do did do the eligibility, this was Good Practice for h. S. S. I think this is important additional language, not to change the policy, but to reinforce it, which Good Practice. We all learn from the last go around. I think this makes quite a bit of sense. I also think we do not need to define that in terms of days, weeks, or whatever. Then we start seeing, i took 31 days, instead of 30 days, this gets the point across without being too onerous for our members. Any Public Comment on this item . I am sorry, yeah, i need a motion. I move that we adopt the edits in the plan document, as described. I will second. Any Public Comment on this item . All in favor . All of those opposed . All right, it is unanimous. Now we have item number 12. Item 12, approval of section 125 cafeteria plan updates. Presented by mitchell griggs, chief operating officer. Mitchell griggs, chief operating officer at h. S. S. This is the section 125 cafeteria plan. This is a federal requirement from entities that have a cafeteria plan, like we do, where money is set aside pretax for certain benefits. It is important that we keep this document up to date, and in compliance with the irs. If we dont, that we have issues of potentially losing that pretax status. This is why we have the documents, and this is why we approve it every year, if there any in your summary here, the summary indicates all of the changes that are in a very large document behind the summary, section b3. 1, the most Material Change that we are making here. We are increasing the amount of pretax dollars, and employee an employee can set aside for healthcare spending account, that is a federal irs regulati regulation. They said those maximums every year, they are inching up about we try to stay up with that come and give employees that benefit. Section d5. 2, we updated the flex credit amount, for biweekly employees, this is a who gave it dollars to buy some pretax benefits, which we have to include in here, because they are pretax. These are set by our agreements with the unions on the association. This is in compliance with the city and labors negotiations. The same for section, or appendix e where we list the benefit programs where we administer. As you are probably aware, we had a large negotiation this year. This are some of the results, the unions listed have been given 15,000 of Life Insurance. Again, the employer dollars that are used to pay for those benefits is nontaxable. We keep that in section 125 pl plan, as well. Appendix e, on page e hike 2, we had a universal Life Insurance that was only available to municipal executives. We have learned, from the carrier, they will not be offering any new policies in 2020. So we have to remove that from the plan document, because we are no longer offering it. We are working with companies that finds and contracts these benefits for us, a replacement for the universal life benefit, potentially. We have a supplemental life with aetna. We will look for universal life, as well. Those are all of the changes to the section 125 plan. Do you have any questions . Im confused about removing the universal life. Those executives, i guess, who have this, even though voya is not offering new policies, are those individuals, who are already enrolled, do they still have a policy . Yes, they can keep it. Does this cover that outcome as well . Does cover the fact that those employees are still keeping it, presumably making contributions to it with post tax dollars . Right. It does cover it, we are not saying what we are saying it is not going to be offered anymore in 2020 for new. Its not that specific in the plan document. I can check to see if we have to specify that. We have a lot to come over the years, of benefits that we have offered. For whatever reason, a particular carrier does not carry it anymore but they are to keep and the members pay them directly. It might be reassuring to those members that have these plans, that are no longer being offered, that they are still viable and that they are not being taken off. Right. Any other comments or questions . If not, i need a motion on this item . I am move the adoption of the cafeteria plan documents changes as described. Second the motion. Any Public Comment on this item . Seeing then. All in favor . All of those opposed . It is unanimous in favor. We are moving right along here, with the heat. Before anybody passes out lets move onto item number number 13. Item 13, reports and updates from contracted health plan representatives. Anything from the health plans . Seeing then. None. Come forward, claire. Public comment on this item . Thank you, clear, retired and play San Francisco. The reason im bringing Public Comment for, i have been hearins item in this action. Ive been hearing for members that their physician are asking them for certain annual fees. Ive heard it anywhere from about 200 1,500 per year that the physicians are asking. We are not sure if it is what they call for concierge service. These are from u. H. C. Members, not kaiser. Basically none of the retirees have discussed this issue, mentioned it, brought it forward, or responded to my questions, want to be identified. They are real people. Im not making this up. The question is, are physicians allowed to do that . Make a request of their members and say, if you want to stay on my patient list, and if you want to get a better response, or you want me to be your physician, pay me that extra 500 per year, or 1,500 per year, or 200 per year, so i keep you on my patient list to get i thought we have equal access, across acrosstheboard, to all of our physicians. Because we have United Healthcare coverage, or we have blue shield. I really cannot say if any of these people are blue shield. Most of the ones i have talked to have all been medicare. We are questioning what this practices, and is it legal within the contract with United Healthcare. What this means for our members . Some members cannot afford that. They dont want to reveal this, because they do not want to lose their physicians as their primary care physicians. They like those doctors, they have been with them for another five years. You understand what the issues are here. The question i have, it seems like it is some kind of extortion. Is this something our retirees are going to look forward to, is it something that people are required to pay, not required to pay . And then, what does that mean . One of do you move to the bottom of the patient list . What happens if you dont pay those prices. I have been in communication with abby and mitchell, this is brandnew to them, from what i understand. The members, retirees, are fearing the danger of losing their primary care physicians if they come forward and reveal who they are. Thank you. Could summary from United Healthcare come up and asked blaine how this works somebody from United Healthcare come up and explain how this works . We have the Medicare Advantage ppo plan, which has an on differential benefits and out of participating providers that are in our network cannot charge a fee to the members to be seen. Not participating providers can do that, its up to the member to choose the provider and pay that fee if they want to see the provider. We cant do anything about that. If you can get some examples, you haveidentify the member, if you can identify some of these providers we can follow up and see if they are in our network. If they are we will definitely take action with those providers. Thank you for that information. This practice, from my perspective has been going for quite a while. This is not new. The concierge services, which is the reason why it has been becoming more and more popular. I think the solution that you have offered, is a good one. That is, if members have concerns than they ought to be able to check with their carri carrier, United Healthcare, for example, to find out what the status of the provider i am quite sure, theres a reason why no kaiser physician does this, because is prohibited. In any ppo network, it would be prohibited as part of the contractual relationship with that carrier. I think there should be a mechanism for them to find out. There are some providers who will, in fact, say, i have a Practice Management consultant and he or she has advised me to change my practice. And now charges additional fees and that will give my population better access. I will ask you to find another provider if they are not in the ppo network. They cannot have both. They cant be in the Provider Network and do that. There is a mechanism. It is not legal for a certain group, but for another group, physicians are independent practitioners, and they have the ability to do that. It can be up to 15,000, per person, or i think it may have gone up. I know a practice where it was starting at 15,000 per person, or 25,000 per year for a coup couple, that was over and above their healthcare plan. This is not substitute for any healthcare. You cannot give up your United Healthcare, or kaiser, or blue shield, if you sign up Something Like this, it is not Health Insurance it is just improved access. Would anybody that did that be considered a concierge, even if they just say we want 125 a year, or Something Like that . Ive heard this before i have seen all kinds of promises being made, certain physicians have said, you know, i dont have saturday off hours, but if you sign up for this additional service, at whatever rate, i will have expanded office hours, including late afternoon, saturday hours. I will promise promise responsive to phone calls i will promise responsive phone calls and email access. They offer a menu of benefits for this category. I have seen people promise this, and actually not deliver. Members pay 500 to have a saturday appointment, and the office is never open on saturday. It is a buyer beware. There is a menu of what this entails. I will say, you know, for members who pay 10,000 or whatever, its an incredible service. Those providers accompany members to their specialty appointments. They close their office, close their availability to other members so they can go see the oncologist. That is White Glove Service in a way that most of us probably dont benefit. Those members who can pay that, do get some service on it may be worth it to them. Any other comments on the subject . Seeing none. Okay, item number 14, please. Item 14, opportunity for the public to comment on matters within the boards jurisdiction. Good afternoon, commissioners. My name is erica, and i recognize that the item i am concerned about, typically speaking is not on the agenda today, the fertility benefits. But my understanding, you do not meet next month, so i wanted to share my thoughts again, just to keep it on the radar. Again, i want to thank you for listening, and really hearing my concerns, and also thank the staff are all of the time they have spent on this. I want to states, as a reminder, that the investigation that was conducted by the department did show that my experience was not unique, or isolated, and it was validated. Also, a reminder, should you make this policy change it does not make the process any easier. I do not think people are going to flock to come do ivf. It is not an easy process. Even with the windows of coverage that i have been able to get, i am Something Like 34,000 in, and i failed in my attempts. So, i think this is an amazing opportunity, although it does not make the process easier, it will allow equity and access to the benefits, which is really priceless. The three things i wanted to point out is in order to make the benefits a fertility benefit, versus an infertility benefit what should be considered for deletion is the demonstrated condition that leads to infertility. That is what makes the difference between something being a fertility benefits, or infertility benefit. If you delete the necessary demonstrated condition, then it would be a fertility benefit. What was being proposed last month, a 50 coinsurance benefit for insemination services. Insemination services is a medical term. It means something very specific. Insemination services is not ivf. It is not retrievals. Its when you take a sperm and an egg to serve to fertilize it. It is not the transfer. It is not genetic testing. It is not egg freezing. Something along the lines of insemination services, egg freezing, ivf and all fertility related services would really get you at, what i think, the commission is looking for his equity and access for all fertility benefits. The last thing is, in the proposed policy, it says 50 coinsurance. My suggestion, for consideration, is to delete the number 50 , it ties the hands of the department to negotiate in the future, potentially more, 55 , 60 . I am not a city attorney, just maybe using the word coinsuran coinsurance. I dont know if that means 50 , or that can mean whatever the differences. To put it in that the policy of the department wanted to negotiate higher benefits, in the future, they would have to come back and change the policy. Thank you for your time. And thank you for giving me more than three minutes. All right. Item number 15. Item 15, opportunity to place items within the boards jurisdiction on future agendas. Any suggestions . Anybody have something they would like to put on our next agenda . Seeing none. Our next meeting, a reminder, is november, not october. Any Public Comments on this it item . All right. We are on item number 16. This meeting is adjourned. I didnt o g is adjourned. I sound familiar do you keep on getting up theres an easier way. Of course theres easier way get rid of of mosquito they breed whatever this is water no water no mosquito mosquito feed on good blood the eggs hatch and stay near the waters San Francisco to breathe and the adult underlying mosquito waits on the as many until its sexuality hardens water pools in any areas and creates places youll not normally think of budget and any container that holds water and hidden in bushes or else were dump the water and do it over soil not into a drain the larva can continue growing in the pooled water is sewage disthe first of its kind the area if the sewage is two extreme have a licensed plumber assist water pools in rain gutters and snaking and cleaning out the water when keep the water from pooling and keep in mind that mosquito breed in other waters like catch balgsz and construction barriers interest crawl spaces with clmg is an issue you may have is week to cause the water to collect this is an sour of mosquito so for buildings just fix the Clean Air Act drains and catch basins can be mosquito ground it will eliminate it as a possible location keep shrubbery and growths estimated any water to can be seen and eliminated birdbath and fountains and uncovered hot tubs mosquito breed but it is difficult to dump the water out of a hot top cant dump the water adding mosquito finish rids the source of mosquito there are also traditionally methods to protect you installing screens on windows and doors and using a mosquito net and politically aau planet take the time to do the things weve mentioned to eliminate standing water and make sure that mosquito are not a problem on your property remember no good morning and welcome to the street scape project and muni project. I certainly as the public works director for the city and county here and i want to thank you for all coming out to celebrate this very exciting project that will improve the lives of the many people who use this inner sunset corridor. The project which spans all the way from aguelo to 19th avenue will improve the quality of life and Transit Services of this diverse neighborhood, which serves families, students, merchants and tourists alike president the street scape improvement is a collaborative project with the ms works and the utilitys commission. For the past two years, theyve been working together to make crucial improvements to the inner sunset street scape and nearby Transit Services that not only make the area more vibrant and more accessible, safe and reliable. When you look around the surround