All right, I am calling the group health care committee meeting to order at 8 34 a.m.

Madam Clerk, can you please do the roll call?

Um human resources director Sean Alterman.

Present.

Acting Chief Assistant City Attorney Jacob Coberly, present.

Sparks Police Chief Chris Crawford.

Present.

Rachel LaRuan Anthem SPPA.

Present.

Darren Partica, IAFF.

Present.

Ann Rolfs OE3.

Okay.

Tanya Ramoschetti, OE Supervisory.

Radika Radakrishnan and Pete.

Carissa Goldsom M Pete.

Kevin Jacobis, Chief Officers.

Lee Leighton, retirees.

Ron Corman, retiree.

We have a quorum.

Great.

Thank you.

Next on the agenda is public comment.

Casey, do we have anyone wishing to make a public comment?

None at this time.

All right.

Moving on.

Approval of the agenda.

This is an item for possible action.

I'm looking for a motion to approve the agenda.

Okay, so you're ready to go.

And it is on the screen.

And you will have on the your tablet the ability to vote.

You don't get a vote.

The agenda is submitted.

Rachel and Anthem S B E A I second the motion.

So did you hit it?

Yeah.

Um, okay, the mover, and then the second should pop up too, right?

We have a second.

Somebody needs to push um second.

Did you vote, Dan?

Oh, I don't have so okay.

We're all learning this system.

Well, that's the first one to mess it up.

All right.

Uh, our three voting members, it passes unanimously.

I guess I'm supposed to say it out loud.

Well, it's on the screen.

Okay.

Next is um minutes.

Oh, thank you.

Oh, look at that.

Thank you.

Next on the agenda is the uh approval of the minutes, consideration and possible approval of the minutes of the Sparks Group Healthcare Committee meeting for November 20th, 2025.

Again, for possible action.

I'm seeking a motion to approve the minutes from November 20th, 2025.

Rachel Rulan Anthem, I move to approve the minutes for the Sparks Group Healthcare Committee meeting for November 20th, 2025.

We have a motion.

Do we have a second?

Darren Barchigai F by second the motion.

Okay, motion by Rachel, second by Darren.

Any further discussion?

Seeing none, please vote on your tablets.

Motion passes unanimously.

Next is item six.

And again, the item numbers may be wrong on the screen, but go by the paper agenda.

This is announcements, presentations, items, reports, and items of special interest.

Item 6.1.

We'll start with announcements from the chair.

Leanne, right over here, is the new OE3 primary representative, and Rachel will be the alternate.

I already mentioned that.

And uh just for reference, when you do want to speak if you're not up here on the dias, and if you're on the dias and you're speaking, I think you have to turn your microphone on.

It's a hard push on this button, apparently.

So there's a request to speak button.

So you go at the top, you're gonna hit your ellipsis as a three dots and hit the request to speak, and that will come up once on the same for you too.

Oh, right there.

Okay, and then that's how you're gonna request to speak.

Okay.

Yeah, we are all figuring out this system because it's our first time up here.

Uh speakers, if you're going to speak from the audience, you do need to come up to the table to present so that it will be captured on the audio and the video.

All right.

Next is item 6.2 announcements from the members.

Are there any announcements from our members?

No.

Okay.

Seeing none, we'll move on to 6.3.

Item 6.3 is the report on the group health fund from the Sparks Finance Department for fiscal year 2026.

Wayne.

There at the presenter's table, please.

And if the microphone isn't on, you can turn it on.

Good morning, members of the group healthcare committee.

For the record, Wayne Weber, Sparks budget manager.

The item before you is our financial results July through December, so half of the fiscal year.

We are currently to the good $746,000.

Screen are you?

I'm just gonna make it a little bigger.

All right.

Uh so financially, the fund is performing very well.

Uh and uh with that, I can answer any questions that the members have.

There are any questions for Wayne.

Nothing currently.

All right.

Thank you.

Thank you.

The next item is 6.4, which is the report on health.

Whoops, excuse me.

Um, yeah, I guess it is.

Report on the healthcare cost analysis review dated October 2025, presented by LP.

Nate, um, you can come up to the presenter's table.

Yeah.

Or how do I get connected?

Let's see if control.

This one and then document.

Good morning.

Nate Kerr with LP Insurance for the record.

Uh, here to deliver the group health plan cost analysis report for the city of Sparks uh through December 2025.

So we actually have complete uh 2025 year.

Uh first exhibit is for active employees.

Enrollment you can see on lines one through four are down.

Um in the employee only category, they're down about one percent.

Uh in the dependent categories, they're down a little over two percent.

Uh line a line 12, the cost per employee uh year to date compared to the prior period.

Uh well, year to date is full calendar year now, so 25 versus 24 employee claims were up about 8%, running at 596.71 per employee per month.

Dependent claims on line 20 were down.

I'm sorry, we're up almost 10%, averaging 1,332 per dependent unit per month, and combined for active employee independent down on line 28.

Uh overall, the cost is up approximately 9%, running 1,473 per employee per month.

Next exhibit is for retirees.

Um significantly higher difference in enrollment.

You can see there are from lines one to four.

I think we've discussed some potential reasons and and thoughts around why that is.

Uh, but enrollment is down quite a bit uh for retirees.

Retiree only claims on line 12 is up about 17% over the prior calendar year, uh averaging 1,292 dollars per retiree per month.

Uh line 20 for dependents, retirees with uh dependents.

Um costs are up about 14%, averaging 1,249 dollars per employee per month.

And we combine the two down to line 28, far right costs are up over the prior calendar year, about 17%, averaging 1,908.

All the normal caveats in the retiree section of volatility, credibility, small group size fluctuations, right?

That we've talked about in the past.

This is a total look, active and retired combined.

So I'll just call your attention down to line 31.

Far right, costs are up over the prior period, about 14%, averaging 1,506 dollars per employee per month.

The next exhibit is total plan cost.

We simply take the claims cost, add in the fixed cost for an all in, uh all in line 31 down towards the bottom there, net uh cost per employee per month for 2025 was up about 13%, averaging 1,670 dollars.

Some notables for 2025.

We did receive quite a bit of stop loss reimbursement.

You can see that down on line 27.

Um not necessarily good or bad thing, but it's a good thing we've had stop loss insurance because some of those numbers are sizable.

Um other than that, overall plan is fairly stable, at least from a claims perspective.

Next exhibit is the incurred but not reported, or the IBNR.

That is the outstanding liability focusing out there that hasn't made its way through the system.

And through December 2025, the IBNR is 1,222,000.

Questions?

Anybody have any questions for Nate?

Come on down.

And state your name for the record, please.

Ron Corman representing retirees.

And my question is is do those numbers on the retirees uh reflect heart and lung type of claims.

So the claim cost for retirees on the exhibit are our total total cost.

So obviously, if related to the benefits, health insurance.

If there was a work comp work comp type situation, that that would not be reflected in these costs.

So these are for the health insurance plan costs.

Okay.

Thank you.

Okay, any other questions for Nate.

All right, thank you.

Next item is 6.5 to report by the um on the City of Sparks group health plan performance by our third party administrator UMR, Russ is on the phone.

Russ.

Good morning, everyone.

Hopefully you can hear me just fine.

Breth Garrett from UMR.

So I'll be presenting.

Um actually my data is through November, but uh it's a little bit more on the uh granular side, I guess I should say, then name a little bit.

But ultimately, uh claims processed through uh November, total number of claims is 41,780.

Of that, 22,000 were medical, 16,000 were pharmacy, and 3,386 were dental.

Through November, you had paid 7.4 million in medical claims, 912,000 in dental claims, and 4.1 million in RX claims.

Roughly that's 12 million.4 uh dollars in total paid with medical, dental, and RX.

Some real good news is the fact that the majority of your claims are going in network.

You can see that 99% of the claims are in network, and you're saving roughly 61.2% on those claims based off of your network discounts.

When we look at per now, I know Nate had mentioned per employee per month.

We do it by per member per month.

And when we look at that, I do feel like there might be a little missing here on exactly medical and RX individually, but you can see those two combined.

You're currently at $651.64 combined medical and RX per member per month in comparison to what we look at like UMR's book of business.

That book of business is taking into account our entire book of business throughout the entire country.

Um, and you can see that City of Sparks is slightly over what we see from my book of business average, mostly due to high cost claimants, specifically related to high cost claimants that have high RX spend.

But that being said, I wanted to point out that there's roughly 1,526 claims denied.

As we've discussed, the denial of a claim can be a vast number of different reasons.

Usually it's duplicates or other insurance.

We're looking for the primary because we don't want City of Sparks paying on something, they shouldn't have to.

And then claims pending right now.

You have 25 that are over 30 days, 116 between 10 and 29 days, 191 claims at 10 days or less.

We've got focused on a couple of the more um you know common uh services, specifically emergency room visits.

You currently have uh 272 ER visits totaling 957,000 dollars.

Uh if you break that down by an average paid per visit, you're roughly at $3,521 in comparison to the UMR book of business, which is $2,374.

That that biggest difference there would be, as I'd mentioned, the book of business does incorporate the entire country.

Uh some of the back east, if you will, and south uh just should have lower costs for ER visits.

Urgent care visits, you have 647 totaling almost 71,000.

And you can see that from an urgent care perspective, you guys are actually lower paid per visit than what we see on the book of business average.

Before I move on to the next page, is there any questions with this data?

Any questions?

None, Russ.

All right.

The next page uh does show our performance guarantees that we have met.

You can see what the target is and where we are actually on all the performance guarantees, uh, payment actually, procedural actually, financial accuracy, uh, claims turnaround uh and average answer speed.

Uh total number of calls that have come in is 1,827.

559 of those were from members, 276 were from dependents, 963 are from providers.

And then when we don't we're not actually able to identify the call, then that falls into the all other category.

Any questions on this?

Any questions?

No, Russ.

And then lastly, I was asked to uh address, and I don't think this is a separate agenda item, so uh I was asked to just kind of give an update on what we had talked about in November, specifically related to the healthy lifestyle claims and some of the challenges that we experienced uh in 2025.

Um just it's with the administration of that.

So uh we have done a couple things.

Uh we did identify a particular issue uh when the claims are updated and posted to the portal.

Uh some of the healthy lifestyle claims were getting uh miscoded and looking as though it was a medical claim and not so much a healthy lifestyle claim, which was delaying the processing of that claim.

Um that has been fixed and new coding has been put into place.

So I feel as though we will not incur that same error as we were last.

We've also put in some updated coding that will help us in the processing time and accuracy of no one member getting multiple checks um due to uh a couple different factors.

But um, so some updates regarding healthy lifestyle.

Um we're also working on a specific routing to go to um a small group of claims processors that are uh more experienced and better uh trained, if you will, on administering these specific types of claims.

So I feel as though that we've made some progress and that uh in 2026, these healthy lifestyle claims will get paid correctly and more efficiently.

Thank you, Russ.

Um, in speaking with Russ, one of the things that he talked about with the healthy lifestyle is we hope that the 2026 claims will be handled um more expediently.

And any feedback regarding those would be appreciated.

Not necessarily those that were filed back in 2025, but from this point forward, if it's if you turn in a claim and it went well or it didn't, let us know.

Anybody have any other questions for us?

All right, none right now.

Thank you, Russ.

All right, we're moving on to general business.

Item 7.1 is consideration, discussion, and possible approval of a revised group healthcare committee rules of procedure.

The rules were revised to show the new location.

And the other change was that for IAFF, it had your old union number, whatever that was.

It was a four-digit number.

Okay.

So we changed that to 731.

Those are the two main changes.

And I am seeking a motion to approve the change of the rules of procedure.

Rachel Ruhan Anthem SPPA, I move to approve the changes to group health care committee rules of procedure.

The annual loss always three and second.

All right, we have a motion and a second.

Please vote.

And it passes unanimously.

Next item is item eight, which is request for future agenda items.

Nate is still planning on coming back.

We have some meetings coming up to analyze different options for next year.

That's still on the agenda.

And part of that analyzing was looking at the speech therapy request that you had about the caps regarding speech therapy.

Particularly only related to stuttering.

But Darren, you were seeking just any and all speech therapy potentially removing that cap, correct?

Correct.

Okay, so that'll be part of that analysis.

Are there any other requests for future agenda items?

No other requests.

Okay.

Next is uh announcements from staff and committee members.

Does anybody have any announcements?

No announcements, just I have sort of one.

The UMR rep is here today.

She comes once a month.

Her morning is pretty booked, but this afternoon she has time if anybody needs to speak with our UMR rep.

She is here today.

All right, no other comments or announcements from the staff and committee members.

Then our next item is comments from the public.

Casey, do we have anyone wishing to make a public comment?

None at this time.

Okay.

Then uh we move on to adjournment, and thanks for working through uh while we figure out this whole new system.

Right.