Calling the group healthcare committee meeting to order at 8 31 a.m.

Shauna Halterman, HR director for the record.

Casey, would you please do the roll call?

Chair Shauna Halterman.

Present.

Vice Chair Chris Cropper.

Assistant City Attorney Mariah Northington.

Sparks Police Protective Association representative Rachel O'Reilly Anantham.

Here.

We have a quorum.

Thank you.

Next item is item 3.1 public comment.

Do we have anyone wishing to make a public comment?

None at this time.

All right.

Item 4.1 approval of the agenda for possible action.

Can I get a motion to approve the agenda?

You can do it on your tablet.

We have a do we?

Yes.

We have a motion and a second.

Go ahead and vote on your tablet.

Oh, is it not working?

Oh, we have a motion.

We don't have a second.

I apologize.

Leanne roll offs is the mover.

There we go.

Second, Rachel a rule and anthem.

And now vote.

Some technical difficulties for those that are online.

All right.

So we do have the motion passed unanimously of those that are present.

Real quick before I move on for the record, Chief Crawford just joined at 8 34.

Hang on here.

That was the agenda.

Next item is item 5.1.

This is the presentation on group health care plan options.

It actually says for possible action, but it really isn't.

We're not making a vote on this today.

A couple of things to note.

This is a workshop.

So what that means for the people here is after the presentation, voting members, non-voting members, members of the public can come up and ask questions.

We may not or may not have answers to those questions at this point, but we'll make note of anything that we don't have the answer to and get back to you on that.

We're going to send a copy of the PowerPoint presentation via email after 24 hours.

So tomorrow.

And again, no uh voting will be taken on this item today.

Nate is going to present, but there's a couple things that I would like to uh bring up beforehand.

Um Nate is with LP, uh Nate curve from our um insurance broker.

I wanted to explain a little bit about.

Oh, and by the way, Nate and I are gonna kind of go back and forth.

He's gonna talk more about the plan structure, and I'm going to be speaking more on the funding side from the city and the impacts to individuals regarding the different plan options.

But before we get started, I want to explain what the city's plan is.

We're a self-funded plan.

Uh that is different than fully insured, where you just buy insurance from somebody else.

Self-funded plan has money that we put into an account to pay for all of the bills for the doctor that everybody goes to.

So when a bill is paid, it's coming out of that fund.

It's not coming out of UMR.

Uh, and that's why we have uh a fund balance that's a healthy fund balance.

A few years ago, I guess three or four years ago, there were a few major claims that depleted that fund balance down to zero.

And it was actually in the negative.

So if you say, well, we have all this money out there, yes and no, we have it to pay the bills for all of the claims that are being submitted.

And we also have it so that if there are large claims, we're able to absorb those costs.

Um it just takes a couple of large claims.

Also, because there's a fairly healthy fund balance right now, and due to some of the cost savings to switching over to UMR, July 1 of this year, we have a 0% increase to premiums.

Nate, on average, what are most experiencing for a premium increase?

8 to 10%, somewhere around there.

Good morning.

Yeah.

Nate Kerr with LP insurance for the record.

Um, yes, this year more than ever, save maybe one year, which was right after the passage of the Affordable Care Act, when the whole world was unknown.

Carriers and plans got a little scared conservative and jumped quite a bit.

Outside of that year, this year is one of the we like to call it hard market for lack of a better term.

It's P and C guys use that term, but the benefits market, it's a hard market now.

We are seeing double digit increases across the board.

Some up in the excess of 50, 50 plus percent.

Wow.

Okay.

It's it's definitely been an interesting uh inflationary period.

So for us to have 0% is unusual to not have an increase.

The only plan this year I've worked on that has been a good idea.

That has zero percent.

Okay.

So I just wanted to give everybody an overview.

It's not a traditional insurance where you pay into the insurance, and then if something comes up, the insurance provider pays.

They are administering our plan, but the funds are coming out of this balance that we have right now, this fund balance.

Um, and we're not doing the regular presentations at this particular meeting because it is a workshop.

Um, and we're looking forward to getting feedback back from you and answering any questions that you have.

All right, Nate, you want to kick it off?

Okay.

Well, take it away.

Nate Current with LP Insurance for the Record.

Uh, this is round round two with the committee.

Um hopefully some of the the last time we met uh with committee workshop, hopefully some themes kind of came through.

Shauna already spoke to them a little bit.

Uh one of those themes and concepts is how do we introduce choice into the current offering?

And the other one is and choice as in benefits and cost.

Both of those offer implement choice.

And then in addition to that, uh, with those types of options, what does that open up or provide potential around conversation for total compensation, right?

Um, as an employee benefits is just a piece of your compensation package.

It's a big piece.

It's an expensive piece.

So how do we provide some some options, some variables in which maybe there we can move some of those funds around within that total comp space, right?

We need choice to do that.

So those hopefully are two themes that came through.

Last time we discussed that is going to be the underlying themes here as we get into it today.

Obviously, when we met last time, there were some takeaways, not only some feedback from the committee, um, but also some follow-up internally with Shauna and her team.

And so today we've met up with a revised uh version that hopefully we can start to zero in on what we think might make some sense.

Yeah, and there were some specific questions that may not be answered today, and we can do that outside of this, but um the majority of the feedback, I think this will answer most of those questions.

So, real quick, I'll just run through the agenda.

Um, there was a there was some questions, comments around specifically what ACA preventive care covered entailed.

What did that mean?

Um, and that arose from the question or inquiry that will how's preventive care covered on an HSA plan, how's preventive care covered on the skinnier PPO plan?

One of my comments or my response to that was it's it's all the same, regardless of what plan, right?

Preventive care is required under the Affordable Care Act.

It's federal law.

It has to be covered in a certain way, regardless of what plan you have.

So uh we just gonna have a list, maybe a little bit more breakout, give you an idea of some of the categories and some of the coverages for preventive care.

Plan options.

I think when we last met, we had a total of three plan options, the current plan being one of those.

Um there was some some requests and sentiment from the committee that maybe can we look at a few more options?

So we've added an additional three options just to give you an idea of what you gotta do with the benefits to to get uh to have a significant cost impact.

So I think we're going to be showing options that range from minus three percent roughly in value to your current plan all the way up to minus 25% of the value of your current plan.

Out of those options, we then revise some of the quote unquote offerings.

That's the A B and C here, offerings that we thought maybe might make some sense in meeting some of those goals and themes that I just talked about.

So we'll go over those.

Um last we met, there was a request for retiree rates.

We didn't have the retiree rates demonstrated last time, so we have that now, and we've broken that out.

Sparks versus Reno cost.

Uh there was an ask to see if we could get a little bit more of a side by side as to Reno and Sparks from a benefits and what employee cost is, both of those.

We had benefits before, but the employee cost component wasn't necessarily in there.

So we've now added that.

Uh premium and HSA contributions, that's uh related to the City of Sparks versus Reno conversation as well.

That's just specific to what do I have to pay for?

What is City of Reno, for example, pay for their HSA plan and how much do they get in HSA?

And based on that, maybe that helps us start to zero in on how we might want to structure an HSA offering here, the Sparks.

Benefit change options.

That is the normal every year a la carte, I call it for lack of a better term, a la carte benefit change options that we always provide to the committee where you have the option to pick and play with certain categories, deductible, co-pays, mix and match, to give yourself an idea of potentially what you would have to do within those categories to move the needle.

So I put those options back up here in the event that we do want to continue down the road.

We always have in the past.

Additional considerations, that's just some uh follow-ups, takeaways, claim examples.

There was an ask.

Hey, can I see you're showing all of these plans?

Can you translate that maybe to what that means for me from a benefits cost?

Obviously, even if I have insurance, I have to come out of pocket, right?

So what might some claim examples look like and what might that be for me?

And then we'll wrap up with questions.

Okay, I won't read read through all of these.

This is that that preventive care list.

Uh the layout, you can see that the Affordable Care Act breaks uh preventive care basically into three categories.

Uh, one for women, one for men, one for children.

Um the same.

There are obviously some unique uh care uh related to those three categories, cancer screening being one of them, right?

Each of those three categories have a little bit different uh testing and services and benefits available.

Um, and then obviously women's specific services, right?

Preprenatal uh breastfeeding, contraceptive, that type of stuff.

So again, uh I won't belabor this.

I did put, I did add into here a down at the bottom there.

You can see healthcare.gov.

That website will provide you all of the details, the explanations, the definitions of each of these categories.

Okay.

Uh this is the first of first three of the six benefit options that we put together.

Uh option one, I think uh we went over this before, but option one was basically taking the city of Reno's plan and trying to mirror it.

It is almost a mirror image of the city of Reno's uh PPO plan.

Obviously, as you can see by the overall percentage down at the bottom there, it's a slightly less valuable plan, which would we would forecast uh some potential savings if you were to move to a plan like that.

Option two is similar type concept.

We picked an HSA plan that was in the ballpark, if you will, or comparable, if you will, to City of Reno's plan, and then what what that, of course, premium impact would be.

Option three is that a la carte uh that I was referencing earlier.

I went in and I just picked off a few different categories, deductible, out of pocket, and prescription drug co-pays, uh, just to see what what that might do.

So you can see there the range there is from 3% to 9%.

Uh, not a new message.

We've said this before in committee many times.

Uh, you you do have to make some significant changes in benefits to have some significant impact to cost.

It is just the reality.

It's not unique to Sparks.

That that is a general statement across the board.

Before you move on, can we dive into the differences in option one, let's say, to the current plan?

A little more in detail.

The reds and the blues.

Sure.

Well, just for ease of eyes, 50,000 foot level, that's what the reds and blues mean.

Red is what we feel is a decrease in benefits or less of a benefit compared to current blue is what we feel is a benefit enhancement or better than what you have today.

Black means in most scenarios, it's basically a wash.

It's it's it's the same.

One of the biggest significant things I would call your attention to on option one is that tier three prescription drug benefit.

That is a significantly different benefit, right?

Today, you just have a $40 copay.

Very, very, very rich.

Uh if you're taking a $100,000 drug, you pay $40, right?

Under the option one, there, which is how City of Reno has their plan set up, it's the greater of a $50 copay or 40% of the cost of the drug.

We all know that tier three, which tend to be specialty medications, right, are definitely the more expensive ones.

So more often than not, it's the 40% that you're you're encountering on that.

Okay.

The good news being the out of pocket is still reasonably low under option one.

It's 3,000.

That includes everything, co-pays, deductible, uh, coinsurance, anything goes into that bucket of $3,000.

So your exposure is capped at $3,000.

But I do want to call your attention to that RX tier three benefit.

And then of course, it carries over the reds and blues compared to current.

Obviously, the HSA plan is a completely different animal.

Uh, it's a little bit of apples and oranges, but again, it it is a true statement to say that an HSA plan in general is significantly skinnier or less of a benefit than what you have today.

Well, and then option one, the primary physician, you're paying 20% after the deductible.

Um, instead of that for a visit, it's a flat rate.

So it's a $20 copay, basically.

Yep.

Um, or a $50 for urgent care or a $50 for specialist, depending upon the cost that that provider has, uh, that could be a savings.

It depends on how often you go to the doctor.

Um all of that.

So depending upon, and that's there's no deductible requirement for that, right?

That's just yeah, because there's no D next to it, which means deductible.

Yep.

So instead of paying 20% out after the deductible, you could go to the doctor and just pay $20.

Correct.

All right.

Any questions on this from the dice so far?

Okay.

We're gonna bring some of these together in some of our plan offering slides.

So we'll they'll be coming back around.

Yep.

Okay, here are the other three options.

I said we were gonna have six with with quite a hefty range.

Uh this plan in general is the same concept as the previous slide.

It's just skinnier.

Um, in other words, we've made the benefits um even skinnier in order to chase some of that cost savings.

So the point of this slide is really to show and get across what you truly have to do to the benefit offering to have significant impact in cost.

Now, on this slide where it's ranging options are ranging from 17 to 25% difference in plan value.

That's that's a lot.

It's definitely a lot, but it gives you an idea of what you have to do in order to achieve those types of cost comparisons.

I don't know that any of these necessarily are realistic, given they are quite an extreme move, but wanted to again at least show and exhibit those for for the committee.

Okay, with those six um options, what potential offerings or combinations do we think might make some sense?

So the first one named plan offering A here, uh for lack of a better term, is uh taking the current plan as it stands today, no change in benefits to the current plan.

That's the first column.

Option one is that City of Reno-esque or City of Reno like plan, right?

Which is fairly close to the to the current Sparks plan.

And option two being that that HSA plan that closely mirrors City of Reno's plan.

If we offered all three of these alongside each other, and the city were to restructure the contribution model that exists today, as a reminder, today the way uh employee contributions work is the city pays 100% of employee only cost and 75% of dependent cost, right?

Very traditional old school model percent of premium.

This exhibit here is moving towards what we call a fixed contribution or defined contribution, as it's sometimes known as.

In other words, we're picking a set dollar amount.

We didn't just pull those dollar, these dollar amounts here, and that's under employer cost, $1,100 for employee only, $1,800 for spouse, $1,700 for child children, and $2,400 for family.

So that is the monthly amount that the city would allocate to you, depending upon which of those tiers you are in.

In order to achieve those numbers, we basically took the current cost, spread it out over the population within each of these tiers, and it's not perfect exact, but that is how we came up with those particular numbers.

In other words, they are very, very similar to what the city is already spending today.

Okay.

So again, the idea we're not trying to increase anyone's cost, really.

We're we're we're trying to provide choice.

Done with that one.

Uh well, I was just gonna say uh one thing to note on this particular offering is because that is a um completely different contribution model, you're moving for percent of premium to define contribution, that would be something internally that uh the committee and the city would have to uh address from a collective bargaining perspective.

Right.

Because that is a struct that is a structural change in the contribution model.

All right.

So before you move on, um that's what I was going to talk about was the mechanics of this.

Right now, the CBAs generally say 100% of employee cost and 75% of dependents.

Each of the CBAs would need to be modified to change it to this flat rate.

In the future, as increases occur to premiums, this dollar amount would be renegotiated, and it would be renegotiated per bargaining unit.

And the reason it's done per bargaining unit is some bargaining units may want something different than another bargaining unit.

Uh so keep in mind if we went this route that um we would need to change all of the CBAs and we would also negotiate as increases occur.

I want to explain what you're seeing here though.

Um, at the bottom where it says monthly and annual employee cost by tier, the current plan is which everybody is paying monthly and annually for each plan.

The new current plan, the monthly and annual amount, you can see the difference between what you're paying now and what you would be paying then.

No change to the policy at all under the new current plan.

There would be exactly what you have now.

The savings would be either one less deducted from your paycheck when it comes to employee and spouse, employee and children, employee and family, or for employee only, the extra $25 a month would either go into an FSA, which is pre-tax, or the employee once a year during open enrollment could choose to get that additional money back on their check under option one, because it is uh a lesser benefit than the current plan.

So it has higher deductibles, but you know, it depends on your particular situation.

You can see the savings in the annual costs of option one compared to the current plan, right there, that would impact people's paychecks.

For instance, employee and family is play paying 524, it would drop down to 2100 annually.

So that's right there, less coming out of your check.

And for the employee only, that annual amount of 1,428 would be either uh into an FSA or into your paycheck.

Finally, the high deductible health care plan.

Um cost savings here.

So when it shows a negative amount, they're not paying any premiums.

So right now where somebody is paying 5244 a year for employee and family, they would pay nothing.

And the city would put the negative amount into an HSA.

Um, did you go over F FSAHSA difference yet?

I can briefly do it, but uh the big difference between an FSA and an HSA is that the FSA funds need to be spent in that calendar year, uh, or you lose them.

Also, if you separate from city employment and you still have money in there, you lose that.

Uh HSA, however, the funds stay in there, they're also pre-taxed, they roll over.

They're portable.

They're portable, so if you separate from the city, you take it with you.

And it can be used in five years, 10 years, this year, whenever you would like.

So in this case, where people have a deductible, let's say that's 2600.

If they haven't, you know, if they put it into the HSA, let's say the employee only, they have $2,200 to play with to pay for that deductible.

If they don't go to the doctor or they only go for preventative, that $2,200 just lives in there and it continues forward.

You are able to change your plan each uh open enrollment period, which is generally in November.

So it could be that a couple years you're on the HSA, your life situation changes, you have money in that account, but now you've got you had a baby.

So you're gonna want to change to a different option.

Um, you can make adjustments one time a year during open enrollment.

Um so hopefully that makes a little sense.

We're gonna do a plan offering B and C in a similar vein, so you can see the impacts to your individual situation and your paycheck.

Great, thanks.

And again, this option here provides choice, right?

In cost and benefits, as well as total compensation option and/or discussion.

Okay.

So it hits on both of those themes.

Offering B, same three plans that we just reviewed.

So benefits offering is the similar.

It's just how do we restructure the contribution amount?

So in this particular example, we have taken the current plan and essentially left it as is.

No change at all.

100% employee paid or 100% paid for employee, 75% paid for dependents.

And we're gonna call that a base plan.

In other words, that's your starting point.

However, you have the option, that's option one or option two, to buy down, if you will.

Buying down meaning that the total cost of those options is less than what the city's already given you, and therefore you can see some of those savings.

So unlike the previous one where it was choice in benefits and cost and total comp, this one is just choice in benefits and cost, right?

Because the amount to the city didn't change.

The total cost is the exact same.

Okay.

This is still using the 100% for employee 75% model.

Yep.

Um, so current plan completely unchanged.

That's what you're paying today.

That's what you would be paying for the next year as we're having no increases.

And the idea being it's not the same exact concept, but those numbers that the city is paying, that's employer cost under current, right?

ER, sorry, ER stands for employer cost, probably should have told you that earlier.

Employer cost, you can see that employer cost carries over to every option.

It's the same on each.

So the city is saying what we're paying today, we'll pay no matter what plan you're on.

Yep.

If you move on to a plan that's a lower cost, then that is less money out of your pocket.

Correct.

Yeah.

Uh when it comes to our salary survey, we're using the same dollar amount as we are now, which is the employee and family.

So it doesn't change your total compensation analysis when we do the salary survey.

This is just individually, what do you need for your family?

How often do you go to the doctor?

What kind of prescriptions do you use?

What's the makeup of your family to see which plan would be best?

And again, in option one, where there's a red that could go into an FSA or into your check.

Option two would go into an HSA or into your check.

Um, while there is an option two, uh still a small amount of dollars paid for an employee and family, 24 a year instead of $5,244 a year, the employee could opt to put some of those savings into the HSA themselves and then um have tax-free or tax-deferred um funds put into there.

Um another thing to note if you're in option two and you're in a high deductible health care plan, you can't also have an FSA and an HSA at the same time with one exception.

You can have an FSA for child care costs only, but you can't have a health care type of flexible savings account and a high deductible health plan HSA at the same time.

And if I get any of this wrong, correct me.

You got it.

Okay.

And just to reiterate uh kind of some of the thoughts or ideas that Shauna was alluding to here.

The idea in this under this offering might be okay, current, which bottom far left, right?

Current today is a family.

I'm paying $5,244 out of my pocket annually.

That's what comes out of my paycheck to have that coverage.

Move to the far right option two.

If I maintain the same cost that I'm paying today, almost all of that now goes into an HSA.

So my cost didn't change.

What I was paying now and what I would be paying under that, call that the exact same.

However, I now have $5,000 as a quote unquote head start towards covering some of those potentially higher deductibles and uh co-pays and out of pocket cost that an HSA does have.

But what we heard during negotiations is that people want more money in their check.

And the way we would have this structured is we wouldn't require you to put that money in an HSA.

That's up to you.

If you want more in your check, great.

But if you have a major medical issue, you're gonna be hit up for $2,600 that you're gonna have to find somewhere.

If you put some money, maybe not all of it, but some of it into an HSA and it's done pre-tax.

Um that may benefit you.

And again, that's up to you as an individual what works best for your family.

Okay, and this is the third combination uh well, third offering, if you will.

Again, same three plans.

So we're not changing the benefits that we're looking at.

But again, restructuring the contribution model.

Now, on the prior slide here, option B.

Remember, we use the current plan as our baseline, right?

That's why it's called the base plan, or we're calling it the base plan.

Here in option C, we're moving that base plan to option one in the middle.

Okay.

And then of course, if you you're an employee who says, Well, but I like my current plan, I like my current benefits.

No problem.

That's still available.

You simply would need to pay the difference.

You, the employee would need to pay the difference to buy up to that plan.

Correspondingly on the HSA, you could buy down.

So you can go either way.

Now, this option also has the two criteria of choice and cost and benefits and total comp.

The total comp piece, probably most significant in this option because under the employer cost, it would go down, it would create some savings, right?

So that opens up funds for potentially reallocating those dollars.

Does that make sense?

I can probably elaborate on that a little bit more.

When we did our total compensation, we plugged in employee and family cost 2385.

Um, if we are an up uh plan offering C instead of 2385, we're using 2177 as the amount that this city is putting in for your benefits.

I did a quick calculation looking at the difference between the 2800 and the 2100 amount, and what I came up with, and some are higher, some are lower, um, but most classifications are impacted by about 2%.

And what that means is let's say we did the salary survey and you were at market, you came in like zero.

So you didn't get a salary increase.

Now you would be 2% under market, and your position would be eligible for a salary increase of 2%.

Um what we had heard during negotiations was that people wanted more money in their check, and they didn't necessarily want such a robust and um very rich health insurance plan.

They'd rather have the money in their check.

If we are now covering option one as the base, you still can have that robust plan, but you'll have to pay for it.

But we're gonna use 2177 instead of 2385 in our total compensation analysis.

Um, like I said, every position was different, but it averaged around 2%.

Uh any more questions on the offerings before we move on?

A B or C.

Okay.

This next slide is uh, as I mentioned earlier, uh there was a request for to for us to show retiree costs.

Obviously, we all know retirees have to pick up all of the cost.

It's quite a quite a quite a heavy lift in many cases.

So here are the rates.

Obviously, these are retirees with Medicare, right?

Because retirees without Medicare, it's the exact same rates as active, right?

So we've already seen those.

These are the rates for retirees with Medicare.

As you can see, they're obviously lower.

Retiree only, eight uh under the current plan, 890 is the total cost.

For an active or early retiree, it's 1,075.

Okay.

So that difference is is because in this particular situation for retirees with the Medicare, Medicare is primary.

And the City of Sparks plan is secondary.

And so makes sense and is appropriate that if the plan, Sparks plan is secondary, they're not going to be picking up as much cost, right?

Of the benefit.

Medicare is going to be picking up most of it.

So we give a premium credit against the current rate based on what Medicare Part B cost is.

So whatever Medicare Part B cost does, that's how much of a discount we provide on the rates, if that makes sense.

And again, retirees here, it may be at least for some who really find that crucial, it provides some choice in cost.

Maybe I can barely afford or I can't afford my retiree cost today.

But if it went down a hundred or two hundred or three hundred bucks, I I might be able to, I might be able to afford that.

So this at least provides choice in cost.

Can you talk about HSA for those on Medicare?

I thought they couldn't have an actual HSA account.

Yeah, that's a good point.

Um HSA requirements, and these are federal requirements.

Uh the federal government says in order to set up, so establish an HSA, because it's a bank account, in order to set it up and put money in to that HSA account on a pre-tax basis.

You can't be claimed as a dependent on somebody else's tax return.

Makes sense.

You have to be in currently enrolled on a qualified high deductible health plan.

That's these HSA plans that we're showing.

And three, you cannot have any other coverage that is not also a qualified high deductible health plan.

Medicare is other coverage that is not a qualified high deductible health plan.

Okay, so what does that mean?

Translation.

When I become Medicare enrolled, again, not Medicare eligible.

I have to have other coverage, right?

So assuming I elect Medicare, then I have other coverage that now disqualifies me from what?

Well, not setting up the count because I already have it set up, at least in this example.

But it would disqualify me at that point in time when I enroll in Medicare, I can no longer put money in to the HSA on a tax-free basis.

Any money that's in there, you can continue to use to pay for Medicare premiums or whatever out of pocket costs or co-pays uh that you have.

So any funds that are in the HSA prior to the Medicare enrollment is still accessible and available.

The idea is that at that point in time, what do we do from a funding perspective, right?

We now have this, we're now missing the funding vehicle on that particular plan.

Right.

So the idea is that most retirees, or what we see is most retirees either will move off of the HSA plan onto some other option, or they will keep that plan and just give up the HSA funding.

Hey, I I like the fact that I can afford the the cost of that plan every month.

So I'm okay staying there and and giving that up.

There are options that the city wants to explore trying to address that, but we can get into that at a at a later date, assuming that you want to go there.

Any questions on retirees with Medicare?

Pretty straightforward.

They're lower rates.

Retirees have to pick up all the cost.

Provides them choice.

This is the slide comparing Reno versus Sparks.

Uh new from when we last met.

We have added in the HSA option that we looked at in our offerings, right?

It was the same HSA offering.

We've added that in alongside the current PPO plan.

So that's the City of Sparks offering.

Uh you can see there down at the bottom.

We also added in cost.

Now, this is employee cost per month.

Okay.

What do employees pay to have that coverage on a monthly basis?

So currently today, City of Sparks, employee only don't pay anything.

If you have a spouse, it's 227 bucks, child or children, it's 203, 437 if you have a family.

Correspondingly, the city of Reno's PPO plan.

Again, it's a little skinnier, right?

We we agreed, not by much, but definitely skinnier than what Sparks is.

Same thing, they don't pay anything for as an employee only, but spouse is $336 a month, $296 for child children and $536 for family.

Bottom line is as a city of Reno employee, I have to pay more for my PPU for the PPO option than the City of Sparks folks do.

I think we already knew that, but we're putting, we're just putting the numbers up there so you can see them.

Correct.

At the bottom, it shows $100 slash $55 for Sparks.

It's $100 slash $50 for Reno.

So Reno is only covering 50% of dependence and spouse.

Okay.

Um now the HSA.

So uh pretty self straightforward with the city of Reno.

The city of Reno says we offer this HSA plan and we contribute.

That's the annual HSA funding here, the blue line.

City of Reno contributes $1,500 for employee only into an HSA.

And $2,400 into an HSA if you have dependents.

Okay.

In addition to that, you still have to pay to be on that plan if you have dependents, right?

So if I have a spouse, I still have to pay $252 a month to have that HSA plan.

Okay.

And it carries down.

What we're trying to show here is that based on the way we've structured the HSA offering, is looking over under City of Sparks there, the HSA, you can see that for basically all tiers, family does have some cost, $2 a month, but I'm gonna call that a wash.

Okay.

So there is no cost out of your paycheck.

And obviously, we looked at some potential funding amounts that we could potentially play with here, right?

Because the cost of the employee is zero, but it's zero.

And then there's still funds left over that are allocated that potentially could go into the HSA.

So in this slide, we have attempted to at least show that from a cost perspective.

Under the potential offering that we may be looking at here for Sparks, there would be no cost out of your paycheck, and you would still get HSA funding.

So that's kind of the the overarching takeaway on this.

This spells it out.

This next slide.

This one right here.

Okay, so the top is Sparks, the bottom is Reno.

Let's start with Reno.

Right now, Reno's HSA plan, that's the annual costs for the employee to pay.

So employee and family, $5,005.

Reno is putting in $2,400 into that family plan, which means the employee is still paying $26.05.

Um, and then you can go up from there.

For Sparks, the far left is what you're paying right now.

The next column is what your premiums would be.

And this is annual.

So $2 a month for employee and families, $24 a year.

So what that means next is this is how much Sparks would put into an HSA for you.

You can see below uh $1,500 for Reno for an employee only, we would put $19.92.

Um, the next one we would put $936, $1056.

We wouldn't put anything in for employee and family.

However, you're not paying $5,244.

So the difference on the far right that could go into an HSA, if you want to, or you could uh take it on your check is $5,220.

The next one up where it says employee and children, Sparks is putting in $1,056 in for you.

Um and these, by the way, are assuming off plan offering B.

If you put the amount that you're paying currently, $2436, because now you're paying nothing into the HSA yourself voluntarily, then you would have $34.92.

Whoops, um, into your HSA.

Same with the one above that, where you're paying nothing.

So you're saving $27.24.

That could go into the HSA for a total of $36.60, because we're already putting $936 in, or the top tier, you're paying nothing.

Um, the $1992 would go into an HSA.

And after speaking with finance, they would allow you just to get that back in your check.

Again, then it's taxable.

Um, you also don't have any savings account.

If you do have a major medical issue, uh, because you do have the high deductible with this.

Um, the HSA again, portable rolls over, stays in there.

Um, so that's the difference.

Because people would say, well, Reno's putting money into the HSA for their employees.

They're putting 1500 and 2400.

Yes, they are.

But the employees are also paying a substantial amount for those plans.

So they're paying, you know, 3,000 2600, 5,000 a year for the plan where you would be paying nothing or 24.

So that was just a little comparison for you.

Sure.

Um Leon Roloffs, OE3 for the record.

For the HSA, and you saying the employees can get it back each paycheck.

Is there a world where like for the beginning half of the year you could be getting it back in your paycheck, and then the last half you put it into HSA or vice versa.

So at the beginning of the year you elect, I want it back in my paycheck, or I want to HSA.

Correct.

It would be too hard to administer to allow people to change month to month, quarter to quarter.

There is one exception to that.

If you have a qualifying life event, um, you get married, you get divorced, your spouse loses health insurance, you have a baby, you adopt any of those qualifying life events.

It's like a mini open enrollment for you for 31 days.

So you have the option to make changes that you wouldn't otherwise have.

But those are specific qualifying events under Affordable Care Act.

Thank you.

Okay.

One more thing to note on the HSA, uh, just to clarify, which is unique to HSA compared to FSA, right?

Which I think everyone is much more familiar with because you have one.

Just a reminder, FSA, whatever election you make at the beginning of the year, you have access to that full amount on the first day, right?

And then you pay it back over 24 or 26 paychecks, however many you have.

The HSA doesn't work that way.

The HSA is you only have access to the amount of funds that are in that account on that particular day.

Depends on how the city's going to structure it, but uh ideally and most commonly what they do is just month by month, whatever we save each month, we and you want that in your HSA, then that goes into your HSA.

So you're only gonna get 112th of that total amount at the end of the year, right?

At a time.

I only bring that up because that is a difference that is worth noting for folks who are very familiar with FSA, but not so familiar with HSA.

That's a big difference.

And really just is it takes a little bit to build up the account in an HSA where FSA it's right away, instant, right?

Once you get that HSA off the ground, you get funds in there, then it actually starts running fairly well.

It's just that first year really is a hump to get over.

Okay, the next three slides are that all a cart change options that we provide every year to the committee.

This is just to give you an idea, and you can refer back to these at a later time, but this is just to give you an idea of uh if you tweaked certain categories, and again, we've tried to focus in on the categories that we feel actually have an impact.

I mean, there are some benefit criteria that you could change that really just doesn't move the needle at all.

So we tried to focus in on some of the categories where it would actually have an impact, uh impact that we could work with.

So the structure here being here's the deductible option, and in combination with what out of pocket max.

Obviously, as each of them go up, the savings goes up as well.

The projected savings.

These numbers are based on your actual performance of your plan.

We do that every year.

So same concept here, but this is also adding in options for office visits, urgent care, emergency room, uh, your ASC benefit, just to give you an idea of if if you made some changes, what that potentially could net for the plan.

And again, all these probably look familiar.

We look at all of these almost every year.

Uh again, same here.

This is for pharmacy and dental.

Uh, you can see there, option three under pharmacy has a pretty significant impact there.

Uh I I think everyone remembers or has heard over and over the prescription drug spend for the City of Sparks group health plan is very high.

Very high as a percentage of dollars that are spent on claims.

Prescription drugs is a very high ratio.

We usually see in somewhere in the 10 to maybe 20% on the high end.

Sparks is floating more like 30, 35% of spend.

Okay.

They have very you have a very rich benefit.

So that makes sense.

So obviously any change in that co-pay structure for pharmacy has a huge impact, makes a big impact because you have a lot of RX spend.

A lot of the savings in plan option one was from increasing the deductible from $5 to $15.

That was the biggest chunk of savings right there.

Some of the additional considerations we reviewed the top two in in our prior um our prior workshop.

So I won't go over those again, but we did add in it was a uh there was a question or inquiry.

Washoe County, they have a PPO and an HSA that are both self-funded.

However, they have a requirement that all new hires have to be enrolled on the HSA for two years, a minimum of two years.

All new hires.

The idea being in that strategy is number one, a lot of people don't elect the HSA because they're just scared of it.

It's it they don't understand it.

It's a concept that is foreign compared to what they're used to.

So they just stay away from it.

Well, if you force them onto it for two years, then they're forced to actually experience it, learn about it, and understand it.

And in many cases, folks, once they do that, tend to stay on that plan.

Not all, but some.

So the question was well, if we did what county did, and we required that here at Sparks, would that generate any savings?

Because the other thing, not only do folks not elect the one thing is folks don't understand the HSA plan, but the other one is the cost to the employer, right?

An HSA plan is skinnier, higher deductibles, higher cost share, higher out of pocket.

So we would forecast that any mandatory enrollment into that plan should generate some savings to the plan, right?

That's not a perfect statement.

That's assuming a normal everyday utilizer.

You could hire a new hire who has terminal cancer and runs up a million plus dollars of claims, and at that point it really doesn't matter whether in the HSA or the PPO, right?

You're the savings is gone.

So based on that average utilizer looking at just the difference in value between the plans, and again, we've shown option one, that's that Reno-esque PPO plan, right?

Option two is the HSA Reno-esque plan.

Option five, I put in there, that's a really skinny HSA, but just to give you an idea of what uh where you would have to go to get really much more impact than the 240.

Um PEPM per employee per month.

Correct.

By the way.

So we looked at the current cost for the city based on the enrollment for the most recent period.

We came up with roughly a composite cost per employee per month, runs about 1,560 bucks.

So if we were to mandate every all new hires have to be enrolled in option one, for example, we would forecast that for each new hire that you have on the plan, you should see roughly 136 a month in in savings from an overall impact to the cost of the plan.

Does that make sense?

And how to navigate that?

Okay.

Claim examples.

We have four scenarios here, four examples uh in the hypothetical, and tried to arrange them from very insignificant or very low cost to very severe, very high cost, and maybe some in between.

So again, using the three options that we looked at in offering A, offering B, and offering C, that is the current plan, the PPO-like City of Reno and the HSA like City of Reno.

Those are our three options.

Preventive care, as we went over early on, doesn't matter what plan you're on, right?

Preventive care is covered at 100% for employee.

So there's no out of pocket cost.

Caveat to that, because I'm gonna get crucified later.

Um preventive care is care that you go in for that is just that preventive.

If I go into my annual checkup, my annual physical, and while I'm in there, I say, hey doc, I have this big sore on my chest, and you know, I've been bleeding out my ears for a while.

Um, that visit goes instantly from preventive to diagnostic.

It is no longer free to me.

I've actually run into that a lot.

Employees come back and said, Nate, you said it was no cost.

Why do I have this $200 bill?

Well, it's because you talked about your sore throat and you had strep throat when you went in there, and so it flipped to diagnostic.

So just caveat there, because that one's coming back around on me a few times.

Scenario two, uh upping the cost, the encounter cost for encounter a little bit, using a specialist office visit as an example.

In this example, we're assuming $350 as an allowed amount.

That's the PPO discounted rate.

Fairly fairly in the ballpark for a specialist visit.

Under the current plan, I broke it into two scenarios.

First visit and second visit, because under the current plan, remember it's deductible coinsurance, right?

So the first visit, $350.

You're gonna have to pay your $200 deductible.

This is today.

You have to pay your $200 deductible, and then you have to pay 20% of what's left over for a total combined amount, which is $30 for a total combined amount of $230.

So that first visit would cost you $230.

The next visit, you've already met your deductible, right?

And the first visit.

So your second visit, you would just have to pay 20% of the $350, which comes out to $70.

So it would be $70 thereafter, to give you an idea.

Option one, which is that PPO plan, a little bit skinnier than today.

As Shauna noted, we have copies on that for office visits, right?

The specialist office visit co-pays $50.

So it's just always $50, doesn't matter, not doesn't matter first visit, second visits, $50.

Option two is the HSA plan.

Uh pretty simple and straightforward there, right?

On the HSA plan, you have to meet your deductible first before any benefits are paid for any category other than preventive care.

Right.

So in this example, the full amount, the full 350 would go against that deductible, right?

Our deductibles 2,600 in the offering that we were looking at.

Scenario three, again, upping the cost a little bit.

I just used a same-day surgery, assuming an allowed amount of $5,000.

Again, the current plan today as it exists would come out to approximately $1,160 in out of pocket cost for an employee.

Option one would be significantly less.

It's $650, um, due to the copay per admit, right?

That we have built on that plan.

And option two would be significantly more.

Obviously, we're talking an HSA plan, you have to pay your $2,600 deductible and then $20 of any cost thereafter, which is equates to uh in this example, $480 for a total of $3,000 out of pocket.

So just to give you an idea, as you climb the scale here, option four is a we'll call it the catastrophic high cost event, although $45,000 these days is sadly not very large, quote unquote.

But that said, $45,000 claim, the current plan would uh cost an employee about $1,200.

That's the out of pocket max today, right?

Option one, it would be $650.

Because you have the deductible and then that co-pay per admit, again, the way we've structured it.

And for the HSA, it'd be $5,250, which is the maximum out of pocket on that plan.

So it just kind of gives you an idea of each plan that we're looking at in whatever category that you're encountering from a care perspective, what that potentially could play out like, just to give you a feel.

No, no surprise here, right?

The HSA has higher out-of-pocket, higher deductibles, higher exposures.

So if I have a big claim on the HSA, it's gonna cost me a lot more than if I have a big claim on the current plan.

Right.

Keeping in mind, remember the difference in what's coming out of your paycheck and the HSA funding you're being given.

Ironically, come out to pretty close, almost as a as a wash, if that makes sense, right?

So that's not being demonstrated here.

We just don't have the real estate to do it.

But that that component is not being exhibited here.

Don't forget what you're paying to be on the plan from an out-of-pocket cost perspective.

Questions?

Comments?

That was a lot.

I understand.

Uh it's it's a lot of information.

For those who are listening, viewing online, um, hopefully you can make a list of questions that we can address later.

Uh, we will be sending the PowerPoints out tomorrow, so you can review those and potentially looking at going out and doing kind of uh meetings in different departments, a little bit of a road show.

Uh, but for now, are there any questions for anybody on the dais first, and then we'll get into any public comments or questions.

If you do make a public comment or question, please come up to the microphone so that the people online can hear.

Anything from up here?

But um, one of the things that came up as I was talking to people were the people who currently have like a hundred percent of their benefits covered.

Do we know how many employees that still is?

Because um, and like how long do we still have to cover 100%, or is that something that's up for negotiations?

Last I checked, there's around 60 people.

And these are people who have mostly been here a while, you know, because that was a benefit.

Um, I don't believe there's any plans to take that from them.

It they would remain in that status.

Um, a lot of those people, the reason I said there was about 60 is I can know I know of a handful that have retired.

Okay, you know, so they've been here a while, they're starting to retire out and um yeah, not be on the plan anymore or be on the plan as a retiree.

And then looking at the examples you showed, the A, B and C.

Um, I know on a few of them the current, like the current plan changed from what like our actual current plan is right now to like a new version of a current plan.

Um, no, I think what you're you're referring to here at the bottom is current plan and new current plan.

Is that what is that what you're after?

These are the actual benefits or these same.

They're the identity, they're identical.

Okay, it would just be the dollar amount that the city's contributing.

Correct.

So what we're trying to show here is this is the world today, the current plan.

That's today.

Okay.

If we were to move to this type of a model, what would that look like?

And that's these three.

And looking at this A plan, the city's actually saying that they would contribute more than what they're currently contributing.

Because I think currently the city's contributing 925, and then that would be the city contributing 936.

It it in a way, it's like I said, it's not perfect.

It is off a little.

Um, you know, you can see here the current world there, what 925 or 95 per month, roughly as employer cost.

That's today.

This is 936.

It's a little bit more.

Okay.

It's not perfect.

And again, we can tweak these numbers, but we tried to get in the ballpark.

Anything else right now, Leanne?

Um, I'm just reading through some of these.

I think a lot of them got answered.

Um to administer from a UMR standpoint, to administer the different plan options, they're still going to charge us the same price.

Correct.

I did verify that.

Whether we have one plan, three plans, the administrative costs do not change.

And then when we look at eventually taking this to a vote, is like an ideal situation that we would vote like plan A, plan B, plan C?

Correct.

Okay.

Yeah.

Rachel Rulinantham S PPA.

Um, so the cost savings to the city, if we were to go to one of these options, what does that say for the city as a whole?

I don't know if that was something that you were gonna speak to a little later.

In most, well, in all of these, really, the cost savings is handed off to the employee because they're not paying premiums.

The city is paying the same in all of these scenarios.

It's just where do you want to shift that money?

So it's a finite pot of money.

In A, it's divvied up a little bit differently.

B, it's pretty much what it is now, but it's the same dollar amount.

You're paying less for your premiums, or you're getting more back on your check, or you're getting money into an FSA or an HSA.

When it comes to offering C, there is a difference because we're instead of paying 2385, we're paying 2177, the city.

But that would be calculated into the total compensation to say, okay, now because your total compensation is your wages and your, you know, um, your benefits and everything that the city pays for you.

It would be calculated at a lower dollar amount for your health insurance, which means potentially it would impact whether you're over market, undermarket.

And the reason I say potentially is it depends on the classification.

So there could be a job title right now that was two percent under market when we did our last study.

Now they would be four percent under market.

So they would get that additional amount added to their salary.

Have, however, if they were 10% over market, now they're 8% over market, they really don't get anything different in their check.

Um, but so the city dollar amount is the same in A and B.

C is different, but with the potential of shifting that savings right into your salary.

Is that okay?

To add to that, with where everybody's at in negotiations now, if there was that 2%, the contracts would essentially like go back to negotiate when that 2% is added, or would that be at the start of the year with the plan change?

It would be negotiated as part of our regular negotiation process.

So right now, most of them, with the exception of one, expire next year or potentially the year after.

It just depends on which bargaining unit.

So that would be part of when we do a total compensation study, it's added in when we do that total compensation study.

The difference I would say in that first plan, where it's a flat dollar amount and um that plan right there.

Now, let's say July 1, we are gonna have a 10% increase.

That would be something that potentially we would be able to meet with the bargaining units and discuss.

What are we gonna do about that 10% increase under a defined contribution fixed contribution here?

You are essentially in that model decoupling the contribution from the total cost, right?

Because you're setting it, you're defining it.

You're just setting a dollar amount.

The percent of premium, they're always tied, they're always coupled, right?

Right.

So keeping that in mind that you you kind of now break them apart into two separate pieces of the puzzle.

Well, in something like this, it behooves the employees to maintain costs, because if costs increase don't happen, then it doesn't impact them at all.

Where if a cost increases for um employee only, the city is covering 100% of it.

There's there's no advantage to reducing the cost of health care overall.

In this model, if they reduce the cost of health care overall, they get something into an HSA or more back in their check.

It's a bit of an incentive to maintain costs and keep costs low.

And so if we got to the bargaining table and and uh potentially, okay, we don't want to absorb any additional cost, but what we'd like to do is make it a higher copay for health uh for prescriptions.

Okay, well, then that'll cover that 10% increase cost.

It just gives you more opportunities, but it would involve uh regular negotiations.

Anything else from the dice?

Because we can open it up to everybody else too.

I know that you were talking about possibly going around to like each location in order to answer some questions.

I don't know if it'd be easier even from like an OE3 perspective if we just like invited you maybe a couple different times or dates instead of traveling around just to the union hall.

Sure.

Um, like if that makes it easier from a you guys perspective so that you don't have to go to every location.

Um, I think that most people would be open to that as well.

Okay.

Well, what we had originally planned was to come back today, is not a voting item, but to come back in June and have a special meeting and do the vote then.

I think that though we're gonna have a lot of questions, and so we're not gonna be ready for a vote in June.

We're thinking of hopefully a July vote.

Um, if this is going to be implemented in January of 2027, there's a lot of work to do for finance for us, uh education, because in the past, open enrollment was who's on the plan and who's not.

That was it.

Now you really need to decide which plan is best for your individual situation, what you want to do with any additional funds, FSA, HSA, into your check.

So it's gonna take a lot more work for HR in the education side, and we need to get a jump on it.

So uh July would be probably the dead date that we would have to make a decision.

There are some bargaining units of the three voting that have to put it out to their members as well.

In light of that, I don't think we're going to be able to do the June meeting and get everything done.

So yeah, we can totally go out, pick days and times to go out and answer any questions, show this information, um, and go from there.

So absolutely.

In addition to UMR has if if you went with one of these offerings, UMR would have to build two more plans, right?

In their systems too.

So that takes a little bit of time.

And you'd have to update your plan document, right?

So we'd need a new plan document.

So there's definitely some administrative lifts, even outside of all the stuff HR would have to take on.

And finance.

And finance.

Yeah.

Yep.

So there's still a lot of legwork to do.

The main goal in this is to option offer options because the way it is right now, there's just one plan.

There's no choice.

Um and people are have different needs at different times of their life.

So this would at least give some options.

But you're you're right that the three voting members here are gonna have to vote for A, B, or C as a planned offering.

Uh for I don't know if you can say anything about it, but just based on how things are going this year.

Are there any projections for how it's gonna look next year in j nationwide in general?

Premiums, costs.

Uh that's a big question.

Uh for Sparks, I definitely can answer that for the for the rest of the world.

Um, seems to be on fire right now.

So uh a little more difficult, I feel like to project some general national uh sense.

So far, we're not seeing trends slowing down at all.

It's higher in certain regions, but even the lowest regions are still running in the eight to ten percent uh health care trend.

Some markets are running in the 20 to 25 uh overall nationally, it's right around that 10 mark for inflationary health care inflation.

Uh City of Sparks has been on a good path.

Um better word is a stable path.

It's been on a fairly stable path.

Not only it's not that your costs haven't moved.

It's your costs have moved in in a very manageable fashion, and you've stepped up year to year to address those, some of those curves through benefit changes through some of these discussions we have in committee through that TPA change we made.

Um a lot of the planned performance today, not all, but a lot of the plan performance today has to do with you now are working with the TPA who is appropriately and correctly managing your plan.

TPA third party administrator with the case.

Third party administrator UMR.

Yep.

So UMR, and it was a little bumpy at first, yes, to get it off the ground, which it always is with any new TPA, but UMR is delivering on their job, which is to be the fiduciary policeman for your account to make sure that stuff is covered appropriately and adequately, like it should be, like you want it to be.

So you you add all those things together.

Costs are ticking up a little, even for the city.

I mean, we see the our claims reports every month, right?

But we go over, and in particular, March and April were not so great.

They weren't catastrophic, but they were definitely not so great.

Um we did our projection with data through February.

So at that point in time, we felt flat, was reasonable and appropriate.

Cost may have ticked up just a little, but we still feel comfortable holding based on the the ending fund, based on how the plan's running.

We feel like holding it flat, at least for next year, is doable.

Will it likely go up after that?

Healthcare doesn't go any direction except up.

It only goes one direction, unfortunately.

Um, you bringing up UMR reminded me of something.

One of your questions was could we have a dedicated phone line?

Um, I did talk to UMR about that.

They're a very large company, and to expect them to dedicate one person that would just know our plan, it's really not feasible.

However, I will say that the UMR rep is here once a month.

Uh she is actually here today.

Uh, she only has two appointments.

Last month when she came, she had no appointments.

So if people really need assistance, she's there for them for those bills and questions.

Um, but I'm not seeing a huge utilization.

When I first started here about a year ago, she was full.

I mean, all of her appointments, but now, yeah, she has two today.

But she's there all day.

If you still need her, she is you can pop in if you have any questions.

To add to that, I think that um, I think maybe people don't understand what they can use when it comes to her, but they can come with like a specific claim and she will work like through that claim with them.

She'll guide them through the process.

So if there is something where they need to appeal a claim, she'll show them how to do that.

Okay.

Um it just depends on the situation.

She will not do dental revision though.

Okay.

Any other questions right now?

I'm sure you're gonna think of more.

And I'm sure people are gonna come to you with more questions, and those are things we can address on our traveling road show.

Uh, I'm sure there's some people in the audience too who would like to ask some questions.

Anyone have some questions?

Dallas?

Yeah, come on up so that people can hear it in the uh on the web.

My name is O'Dallas Rodriguez.

I'm the representative for the confidential group.

Hello, I have been reflecting on the goals of the city and this committee, which were to be fair and equitable.

During the comparison done by the city, staff were told their salaries were affected due to receiving health insurance plan benefit of $2,385 a month.

Now that the group healthcare committee is trying to give us more options, I've noticed that none of the options reflect that all employees are being given that amount.

Why do none of the options presented reflect the $2,385 that the city states it is giving us?

The only fair option is to give staff the amount the city pays for the family plan and to provide the rest in their salaries while also giving them the option to switch to a high deductible plan.

For example, the city paid $2,385 per month for the family plan in 2025 and is now paying $2,395 per month for the same plan.

We want the city to continue giving their employees what it would pay for the family plan.

The employee would then choose if they want to switch to a high deductible plan to save more money or to stay on the current plan.

The benefits of following this recommendation are that one, the city is being fair and honest when it states they are giving us $2,385 per month in benefits.

Two, the insurance policy stays the same.

That means the same deductible max out of pocket expense, et cetera, for employees who choose this option, or it gives the employee the option of a high deductible plan.

The third benefit is that three of the four plans will no longer pay for health insurance.

For example, the employee only plan will not pay out of pocket, but will receive $1,310 more a month.

The employee with spouse would not pay and get $403 more a month.

Employee with child would not pay and get $498 per month.

And the employee with family would remain the same, paying $437 a month.

And the fifth benefit is that the city has funding for all employees to be on the employee with family plan.

Therefore, would not cause a financial burden to the city.

Per our last group healthcare committee meeting, it was disclosed that the plan is healthy.

Okay, I can address most of that.

Can you bring up B, please?

All right.

On the left-hand side where it says count, those are numbers of people that are currently covered under the on the plan in each of those categories.

The total underneath that, I can't read that one.

No, I'm to the right.

The next one over $1,000 47, thank you.

$1,047,000 in change.

That is all of the number of people at that rate.

Okay.

So the next column over shows what we're paying per month for as an employer, correct, Nate?

The bottom of that, the $900,000.

Correct.

Is the city's portion that we're paying.

So if you're proposing that every single employee receives the benefit of $2,385, then that number is going to go up substantially.

Because right now, for employee only, we're paying $1075.

So if we gave them $2,385 for every single category, that number's going to go up substantially.

That number is going to count towards the total cost of compensation.

So basically, I'm giving somebody an employee only an extra $1,300 a month.

That comes out of your total compensation.

If I'm going to give them richer benefit like that, their salary is going to go down.

There, it's a finite pot of money, whether it's spent for health care, whether it's spent on your paycheck, it's the same pot of money.

We cannot increase the health cost benefits to 2385 across the board.

We did propose last time an equitable way to say we're just going to say every employee, we're going to take that 900,000 and divide it by the number of employees, 522, ended up being somewhere around 1888.

So whether you were a single person, a family, spouse, children, you got 1888.

That's the most equitable way to do it is to say, here's this finite pot of money.

We're going to divide it evenly amongst employees.

If we increased that finite pot of money, the money has to come from somewhere.

It has to come from your paycheck.

It has to come from some other benefit because increasing that pot of money, uh, it's like I said, it's a finite pot.

It has to come from there.

The fund balance is healthy because of cost savings from UMR.

But again, all it takes is one or two big claims, and that fund will be depleted.

Um, claims are paid out of that fund.

That fund is not used for premiums, it's used to pay the actual claims.

Um, we have a few claims.

We have one that's over a million dollars a year for a prescription.

Um, so you have a few of those, and before you know it, that that fund is depleted.

So hopefully that sort of makes sense.

Um, sort of explains it.

I get what you're getting at, but I also understand that when I did my compensation, you know, instead of the haze study, they're saying that they're giving me that benefit and they're not.

I think the fair thing to do was to say, hey, we're paying city, county, whatever, everybody's getting their employee costs covered.

That's something that uh we all are out getting paid, right?

So like a thousand dollars and use that for the comparison that was done instead.

You guys choose the highest number, the $2,300 85.

And it comes across as I keep hearing we want to be fair, we want to be fair, but it ends up looking like it's the convenience for the city and saving the city money.

And if that's your point, then that's fine.

But if we're looking at it to be fair, it's you see a it's like 60% of us don't have the family plan.

So we're not getting that benefit that you guys are stating that's going against our income.

So we just want to make a point that we don't agree with that.

Okay.

I I hear what you're saying.

Um, that is the potential liability that the city has.

It is a standard process to utilize the highest liability that the city would have, which is employee and family.

And when we're comparing to other agencies, we're also comparing comparing to employee and family at those agencies.

So across the board, theirs is the same.

Uh, employee and family.

We're looking at the same analysis.

We're not complaining comparing our employee and family to their employee only.

Um, but that is the opportunity of liability that the city has at any time people could switch to employee and family.

Why wouldn't they use the employee only number when doing the comparison all across the board instead of the employee with family then?

Because the majority of the people are employee and family, and that is the potential liability that we could have even more people on employee and family.

And that's a standard way that the industry does uh a compensation analysis.

Okay.

Can I add real quick?

Um I know that last oh, I think it's sorry.

Um, I think that because last time you did have that option where if everybody had the same amount, yes.

Can you guys create an ABC but now D with that same amount that we could compare it to as a possible voting option?

If that's something that the confidential they don't get to vote, but it'd be something good to consider for them.

With the 1888.

Uh, if that's the average of if you take that 925 and divide it into the four groups, um, yeah, using the average with the same consistent number for each one.

I think that would be nice to see.

We could we could add that in there.

You already have the math.

Um the the impact were was that an employee only would end up with like an extra 800 a year.

Um, or eight actually 800 a month.

Yeah.

Um, the employee and family was paying another, I can't remember exactly how much, like 1200.

500 bucks was more a month.

And that's why I don't agree with the 1880, because even though I'm an employee only, I don't agree that this family over here is gonna end up paying 500 of the the 800, you know, it's like one and a half of them is paying me.

So I don't agree with that either because I have my family and I don't think that's fair.

Well, we're treating everybody, every employee the same.

Yeah, no matter what their life situation is in that scenario.

Right.

And that's why the 1880, you could say it's trying to be, I just don't get why it can't be the 23.

If the 1880 is a possibility, why can't the 2385 be a possibility when you're already throwing out giving a set amount of 1880?

Because 1880 is taking that 900,000 that we're already paying and dividing it up amongst the number of employees.

If you were to do 2385, that 900,000 is now gonna be 1.2 million, 1.4 million, whatever.

I can't run the numbers, but it's going to substantially increase.

That money has to come from somewhere.

Where would you come up with that money?

Isn't wasn't there a $9 million fund?

That's to pay the bills.

And not to fund the difference.

It's to pay all of those bills that come in for all of the medical treatment.

Because the way that I think of it is okay, if the city's gonna give me $2,385 or whatever it was, hypothetically speaking, it's the bills that will brings that $9 million down.

And if I were to get that money, I would switch over to my husband's, keep my $2385, and no you guys are no longer receiving any bills from me or my family.

Then maybe the case for you, but it might not be the case for somebody.

But for most people, there is a it would be cost saving to the city because now you're having people get off the plan and going to their spouse's plan, and then they're getting the money, same way that you're offering to give 1880.

So if they don't have a spouse, it's employee only, and right now we're covering them at a cost of 1075.

Now we're giving them 2300, there's no benefit to the city for that.

There's just an increased cost because there is no spouse's plan to go on to.

Correct.

Yeah.

So that's just an increased cost to the city of $1,300 a month that has to come from somewhere.

So where would that come from?

Yeah, I figured it was from the $9 million.

That's to that's to pay the bills.

Yeah.

And like I said, just a few years ago, it was negative.

Yeah, so that that money is there to pay for all of those costs.

We have a couple of large claims, it's it's depleted.

Okay, and then how much does the city get annually?

Because there has to be a budget for it that the city puts into this fund.

Do you know what that number is?

I don't right off the top of my head.

I can I can get back to you on it.

Okay, yeah.

If Wayne were here, he would know right off the top of the set.

Do we have the bottom?

I know the last time when I was a CF on the committee, there was like the bottom line amount that we had before we were looking at increasing premiums.

Do we have like in today's numbers what that number would be where we would have to be like, we're gonna have to look at increasing premiums?

Um I don't know if there's really a a number.

It's it's more of a trend, I think.

But the number you're referring to, are you are are you talking about the ending fund balance?

The ending fund.

Okay, yeah.

So that's I don't know where exactly where that number is.

That's a finance question, but when we go through our projection for rate setting, we don't take that into account.

Call that your call that your savings account.

Okay.

We we don't take that into account.

We simply say, based on your performance, prior performance, we're gonna forecast what we think your cost will be next year.

Okay.

And then we're gonna give you the difference on what you're funding today versus what you would need to fund to cover that.

That's the increase that we do.

Okay.

You as a committee, you as an organization decide how you want to handle that number.

You could say, look, Nate, you're telling us we need 3% increase.

Instead of increasing our rates 3%, we're gonna hold our rates and we're just gonna pull 3% out of our reserves out of our ending fund.

Could you do that?

You could.

And these are all the options and moving parts and how to manage a fund.

At the end of the day, the rate increases that we come up with literally just that math.

It's reality.

What are you paying today?

And what is your cost today?

What do we think your cost will be tomorrow?

And what would you need to pay to cover that?

That's the difference.

Does that help?

Yeah, that does help.

Okay.

I did just get some info.

Somebody texted me that uh it's approximately 12.5 million that goes into the fund a year, and that's a combination of city and employee contributions.

And then 9 million that was left last meeting, was that left over from last year?

You guys had 12.5 and you only use 3.5 is my understanding, or couldn't answer that right now.

But you want to have a good healthy amount in that account.

So to have a year's savings is not an unreasonable to have that in there because you don't want to end up in a situation where there's no money left.

But uh yeah, so about 12.5 million.

Um, also I was texted to remind everybody to say your name before you talk, which I fail at regularly.

Like Chris Crawford for the record, I might be able to help maybe just a different way to look at it, because you guys are all talking about is the same pot of money.

So if you do 2385 and say you start going after the nine million, it's gonna be at five, probably by the end of the year and three.

And so if people get off a plan, there's less people using it.

So what that means is Nate and his crew are gonna be recommending to the city significant premium increases to cover that.

So yes, you're going to start taking away from that four years ago.

We were in the red.

So yes, that's all possible.

But if we go to 2385, that big chunk of money starts eating away, which then takes away other benefits and raises premiums.

That is how the city can address that because there are other funds and salaries.

So what Shauna and team have been working on is hearing from the employees is I want more money in my paycheck.

So there are some options here of using that pot of money.

And one of the main purposes for the group healthcare committee is to maintain costs.

Um that's the purpose of the committee is to analyze and maintain costs for the group health care plan.

Again, I didn't say my name, but thank you.

Thank you.

Any anybody else have questions?

Come on up, Lee.

My name is Lee Leighton.

I represent the uh retiree.

You kind of briefly looked a little bit at the I didn't see any benefit to retirees that are uh under Medicare age outside they could they could have uh a savings account.

So the the main benefit to retirees with Medicare would be their costs would go down.

So today, if I'm a retiree only to keep my and I'm a retiree with Medicare, I have to pay $890 a month.

I now have a choice, assuming this offering went into play to now drop down to $796, maybe $100 a month less, and so on and so forth.

And obviously it gets bigger, the numbers get bigger the farther.

So there is a benefit for the retiree on Medicare.

Cost.

Yep.

Cost to the employee.

The retiree that's not on Medicare.

Um the same as the act it's the active rates, so it would be these rates.

So this technically, this should say monthly active and early retiree rates, right?

Because retirees without Medicare and actives are the same rate.

Okay.

So the real cost benefit are for retirees on Medicare.

Oh, retirees.

Because they can't have the savings account.

They're just basically getting a redo.

It's the same dynamic, regardless of whether you're on Medicare or not on Medicare.

The idea here is that you would now have some choices that are cheaper.

Now you don't have a choice.

We say the cost goes up 10%, you have to eat all 10%.

As a retiree, you have to eat all 10%, right?

You have to eat the whole cost, the total cost.

This, and you don't have choice.

This provides choice.

It's introducing choice.

So now, as a retiree, you have two cheaper options.

Okay.

Available to you from a cost perspective.

Okay.

You know, as a retiree, this is the first time I was really exposed to this, and I it's there's a lot of information there.

And uh the motivation behind this, uh, this has been brought up several times on cafeteria plans, and it wasn't exactly this type of a plan.

Uh this this is kind of rather complicated.

And I think employees thinking they're going to get more money back in their paycheck is uh is a false sense uh because you're you're gonna pay if you have medical problems, you're basically gonna pay the additional costs as you have your medical problems.

So it's pay me now or pay me later.

It all depends, you know.

Health insurance, we all pay into health insurance, and we all don't use it the same.

And that's why it it's a it's a that's that's why it's successful.

I don't use it as much as somebody with a family, but we still pay our premiums and they're still high to help support that because one single person can't afford a lot.

The City of Sparks' health insurance plan is probably one of the best that I've been involved with for a long time.

I've been on this committee for a long time.

I think they really need to look at this very carefully.

And employees that think they're gonna save money uh by getting money on their paycheck.

I think I think they've bit watched that very carefully, and I hope they're very skeptical before making a change this significant before they just jump into this, because it's you might say you can go, you can pick plans, but this is more complicated and affects more people's lives than we might think.

Uh and the thing on no raises this year, a little history.

Uh many few years back, uh, we got a reduction in our premium uh for two years.

They reduced our premiums 8% per year.

And the next two years after that, they increased our premium 25% per year.

You have to understand that the health benefit plan, the money that's put in by the city can't be touched.

The city, if because there's a windfall of money in there, the city can't come in and take it out of there and use it for an expenses within the city.

But what they can do is they can cut down the and not contribute to it based on the facts is don't have a raise.

And we talked about this before on this committee and said, you know, we should we don't want 25% increases.

We want incremental things that we can afford 3%, 2%.

And I kind of it's a red flag to me when I see no increase in health insurance.

Basically, that doesn't follow the trends in health insurance, doesn't follow the trends in inflation.

And I would project that the city needs the money.

You know, they don't want to pay because they're the largest contributor.

And I would project you are going to get a raise, but it's going to be more than the little 2% or 3%.

I I think you got to be very careful about not putting in follow at least the cost of living into your health plan.

The bottom line, it can change in a moment's notice.

Next year you can have large claims.

And because there's an extra amount of money, it goes away.

And the other thing is this health committee can offer better benefits if there's too much money.

You can offer things that you don't already offer.

I mean, preventative care can be expanded greatly.

So it's basically there's other things to stop people when their health care besides the little things that we address, which is a little t-physical.

There are you could spend money really proactive and preventing people's health problems.

And I think if you have additional amount of use that, but I think I think the committee, the voting committee, should question these kind of things.

The financial part is very important.

And uh from the retirees perspective, I think we're gonna just hope that the decision that's made by the voting takes in consideration, retireed what you think could be best.

But the plan we have is is a is a pretty good plan.

And to change it is is a pretty important decision that you're you're making.

And look at it very carefully before you make your final decision.

Thank you.

Thanks, Lee.

Um, a couple of things to address on that.

All three of these options, A, B, and C, include the current plan.

You would still have the current plan if that's what you want.

And as Lee said, everybody has different needs for health care.

Everybody's in a different place in their life, different utilization.

Somebody in their 20s hasn't seen a doctor in five years.

They they don't need this robust of a health care plan.

Somebody with children that are regularly getting injured might need a different plan.

The whole goal of this is to offer options.

Um, but the plan that you have now is the current plan option in all three of these plan offerings.

So it's really no change.

Um the the what the feedback that we got was I don't want this really rich plan.

I want alternatives.

And so that's why we're offering a less rich plan or a high deductible health care plan.

And it all depends on your needs, your utilization for your family.

Um, but we're not changing the current plan in any of these offerings.

Nate with LP, maybe just one comment as well.

Um basic insurance principles, right, is what Lee alluded to.

Um spreading the risk across a spectrum.

Regardless of whether we do that using one plan or using three plans, that principle still exists, but to the point, and it is true, it does complicate things, right?

Three plans, offering three plans in a different contribution model versus one plan and a percent of premium is just more complex.

There's more moving parts.

Um, so while the principle still exists of spreading that risk, you you are always gonna have levels of inequities, right?

Um, the prior um presenter or person, I'm sorry, I forgot your name.

Um had had mentioned the difference in cost per tiers.

And again, same type of situation.

Obviously, someone with dependence is getting more from the city in contribution than an employee only.

The only alternative to that is to not pay anything for dependence, right?

So, in order to maintain the equity.

So you're always gonna have some some slight inequities in that regard in an environment of risk sharing in a pool.

Well, and that's another point that you bring up.

We're self-insured.

We're not fully insured.

So when you're looking at a fully insured plan, they're looking at all of their members and the volatility of the plan changes depending upon how many bodies are covered, how many lives are covered.

When we're a self-funded plan, we're not part of a greater pool of people.

Um, we have to be a little bit more conservative to make sure that we're covered in the event that we do have large claims.

Uh, it's a different market when it's just the 522 people as compared to 10,000 people.

You have more flexibility with that volatility volatility up and down.

And so when we're looking at are we increasing or not, it depends on how much we spent the previous year, two years, three years for our health care costs.

And because there's a smaller group, that volatility is much higher and much lower.

So probably why you saw the negative one year and then it went up the next year, because we're assuming this is the number of average claims and costs we get, but you never know.

You could have a few big claims.

Any more on that?

Did I kind of cover that appropriately?

Yeah.

Yeah.

I I think there was a decision in in the prior examples to deploy some reserves, which created created some of that cost relief.

Um and then perfect storm, we ran into a really big year or two.

So the swing was pretty dramatic uh dramatic in that point.

I think that was Lee's point was kind of leaving it a little instead of having peaks and valleys, yeah, maybe leveling it out.

And there's no right or wrong.

We have employers that do it both ways.

That they'll take 15% decreases one year and then 20% increases the next year, and they'll ride that instead of taking a 5% increase one year and an 8% increase the next year, right?

So there's no right or wrong way to do it.

Um, and year to year, employer by employer, that that can shift.

And those are conversations that we have with HR and finance on on some ways to go about that.

Leanne, did you have something else?

Yeah, um, Leanne OE3 for the record.

I think that some of the frustration or things from employees or that they see employee only not getting as large of a benefit of an employer contribution as employee family.

But I think if people better understood why those numbers are being allocated the way they are per each, what you're claiming, um, maybe it would help explain it.

Like, is there a way for you guys to explain, okay, like we give a larger amount to employee family because this or employee only?

Is there a way to explain that to everybody?

I don't know.

I'd have to think I know what you're saying.

Like, yeah, like how did we pick 2385?

Like for that part.

Yeah, yeah.

Could that number go down and be allocated more to the other three groups instead of being four equal numbers or well, that's kind of what plan A is flattening that out with a flat amount.

Any of that is possible, but then you're gonna have some groups do better than others.

Um, that's why that 1888, so everybody gets the same amount is really the most equitable way.

I mean, most agencies will have one amount for employee only, another for employee independence, employee children.

Um, all of our comparable agencies do the same thing.

It's kind of just national national, the way it's done.

What else have you seen out there besides that?

Very rarely have we seen just a composite composite cost for by tier with that with that composite cost being two to three times higher than an employee cost even needs.

Right?

Because you're creating some weird dynamics there.

So even in this option A, though, the employee family number increased.

Is there a way to not increase their contribution?

It went up $15.

Yeah.

Yeah.

But um, to give like employee only employee spouse and employee children a higher amount from that pot instead of just employee family getting the largest portion.

I mean, it's possible.

It's it's the $936,000 up there divided in different ways.

But if you change the amount you're giving to an employee and family from the city, they're gonna have to make up that difference out of their check.

And you have 60% of the people at the city of Sparks in the employee and family plan.

I don't know if that would go for a vote.

Except if so, like when calculating a comparable employee family is the amount being used.

So now since that's the city's highest liability, if that number decreased to a lower amount, then I essentially when we're doing sorry, Leanne, for the record.

Um essentially, then when you're doing a comparable, that larger liability amount would reduce.

So then technically our comparable amount for our wages should then increase.

Exactly.

And that's what option three is.

Okay.

So option three is uh, or C, can you go to C?

Sorry.

Uh option C is we're no longer allocating 2385.

We're allocating 2177.

And so when I take that and I plug it into the spreadsheet that says how much the city is, that's the 2% difference.

Give or take, some positions more than others, but approximately 2% difference in the spreadsheet that says your over market, undermarket, all of that.

Yeah.

So that's where that makes sense.

This makes sense.

I think that like getting at the same point of like employees not wanting that employee family to be such a large contribution, you are giving us a plan that has that lower number.

That's an option, yeah.

It is a different plan though.

Yeah.

So it is now the PPO 400 plan is now our base plan at 2177.

But we still allow you the option of the current plan, but you're gonna have to pay more per month.

So an employee and family would pay 400 under the option one plan, which is less than they're paying now.

Right now it's 437.

If they want the PPO 200, they're gonna pay 645.

But to make sure I'm understanding the current plan though, would still change from our actual current plan.

Yeah.

You mean the makeup of the plan?

Not the makeup of the plan, like what people are paying.

So I think like what the feedback was for most people is like they want to always have our current plan and prices.

No, okay.

So it's this one, it wouldn't be it wouldn't, yeah.

But in or B and C it is in B and C the current plan is is still this uh or A and B, the current plan is Yeah, Nate with LP with the record.

Uh plan B is.

Plan B is that right here.

So plan B so this is the world today.

Yep.

And we are saying this would, in our scenario here, this would be the world tomorrow, right?

Look down here.

And it didn't change.

The current plan and the new current plan, nothing changed.

It's identical.

So this is the world today.

This would actually lower employee cost for the current plan.

Right.

And this would increase cost for, but again, the variables that go along with that are what do we do with those differences in funds?

If you use it all on benefits, great, you use it all on benefits with either an A or B, right?

A or B options, you're using all of the funds for benefits.

Option C gives you a component where you don't use all of the funds for benefits.

So potentially there's some left over to be reallocated as an option.

Correct.

So what it what everyone needs to hear is this is the city listening to we want options.

We want the option of different plans, money in my paycheck, money going somewhere else.

That's what this is.

Sean and team has done a lot.

There is going to be a there is no way to make everyone happy, as you see.

There's employee plus family, which is 211 employees, employee only 173.

There is no way that they're gonna make everyone happy.

So we know with our city, I've been here for 23 years.

There was a time, a long time that I was employee only, and then employee spouse.

And so we all are our needs will change.

Those numbers will change every three to five years on average.

We have a lot of new staff, so I'm willing to bet things will change.

But just what we need everyone to hear is Shauna and team will come around.

There are a lot of questions, please ask.

Um, one highlight that we don't have an option for as an employee, an HSA is a pretty cool thing.

So think about your deferred call.

That is money that can become yours.

You may leave the city in five years.

It goes with you.

Right now, nothing goes with you.

So NACO the record.

Um, it also lowers your income.

You can lower your deductible income, your taxable income.

So it's another benefit.

But you're all asking great questions, just this is what was asked, and they've done a ton of work, so keep asking.

But our coworkers have different needs.

Yes.

Nate for the record, one last comment.

Um I would say it is very, very rare.

I'm trying to think of another public entity.

I can't really think of one that only has one plan.

Um very traditional.

Look back 15 years, maybe maybe a little more than that.

Yeah, yeah, everyone had one plan.

Now these days, most all employers, public and private, have at least two plans.

Again, because you're trying to address choice along with benefit, right?

You're trying to have both.

So a racheliniant MSPPA.

Um, I think we might have discussed it at the last meeting.

Uh, but we chose City of Reno because they have the most similar structure to ours in terms of benefits, is that correct?

And and then Washoe County was quite a bit less, correct?

Okay.

And I think different committee members brought that up as examples.

They're like, well, why don't we do what Reno did?

That's why we did that little brief comparison.

The biggest difference with Reno is they are paying for their premiums.

And with our high deductible, you wouldn't 50%.

Right.

And the 50 versus 75 is substantial difference.

Um, any other question, Leanne?

Did you have something else?

No, no.

I mean, I just want to say, Land, for the record, thank you.

I know this is very time intensive in answering all of our questions is a lot.

So I don't want um you guys to feel underappreciated.

I think that the big thing, especially like now joining negotiations is people wanting more money each check to keep up with their way of life.

And you guys listening, hearing that, and making the accommodations to get our questions answered are appreciated.

Well, and we too are employees.

And we want choice as well while maintaining costs.

But right now there's one plan, and that's it.

Um so yeah, thank you.

I appreciate that.

Anyone else from the audience that has any questions right now?

I know it's a lot.

We'll send the PowerPoints out tomorrow so you can take a look at them.

Um, and then if you have any additional questions, I'll work with the different department heads to do some meetings at different sites and different locations and dates.

So hopefully we can hit a number of people.

Uh I'm sure we'll get some more feedback too from the people that are watching online either live or later as well.

Um, so no other questions on on this.

I really want to thank you, Nate.

You did a fantastic job, and we went back and forth on many iterations of this PowerPoint, and I think you sent it to me at 10 30 at night.

So thank you for all your hard work.

I've been dreaming about numbers the last few nights.

I I think I know why.

Yep.

All right.

Nothing else for this item.

Um, I do want to warn everybody, every single one of the computers up here decided to do an update and shut down while we were talking.

So the rest of the meeting we're going to do just off of the paper agendas.

There's only one other item um on here.

We're not gonna vote on our tablets.

Yeah, so um, I'm gonna try to record the vote either on the um software that we have on the computer, or I'll write it down and it'll be placed in the minutes as if you guys voted on the tablet.

So if you could just um read out loud.

Um, and then I should be able to still get the recommended motion up so you guys can still read that off.

Okay.

All right.

Then next is 6.1.

There we go.

This was mentioned in the PowerPoint slide, but this is the one action item that we have voting item today.

And this is review discussion and consideration to remove the 25 visit cap and add medical necessity review to speech therapy as applied to other therapies.

And a little background on this, and if you have any additional questions, Nate can can do so uh address it as well.

Is um like other therapies, there is sometimes a cap for that service for each year.

The proposal brought forth by another committee member was to remove that cap.

But what would happen is if somebody wanted more than 25 speech therapy sessions, they would need to uh go under a medical necessity review to make sure that there is a medical need for more than 25 um additional speech therapy.

The fiscal impact was fairly low.

It was in our other uh presentation, a few thousand a year.

And that of course is an estimate because it we just don't know how many people are actually going to need more than 25 visits, but utilizing the the amount of utilization right now, uh it was estimated around $2,000, I think a year.

Clarify the review personal doctor.

Oh, who does the review?

Um, the review would be UMR.

Uh they sometimes will do what's called a peer-to-peer.

So they'll call their UMR doctor will speak with the speech therapist to determine what the medical necessity is.

Maybe they're just gonna authorize 10 more visits or whatever it may be.

Um, but yeah, so UMR does the review, but they do coordinate with the provider.

Any questions on it?

Uh Rachel Rulinantham, SPPA Mariah.

I guess you'd be my person to to ask about this.

Was there a legislative update?

So this is speech therapy in general, but was there a legislative update where it was speech therapy in conjunction with autism, I believe, where there's no limit at all.

I'm gonna hand this off to Shauna because we would like to know nodding.

There was you can address it as well, but yeah, that was specifically for autism.

Yeah.

And this is just in general.

This is just in general.

Okay.

Yeah.

Any other questions on this item?

No, I think we're gonna do about then.

I am seeking a motion to approve removing the 25 visit cap and uh applying a threshold for medical necessity review at the 25th visit for speech therapy, as it is applied for other medically necessary therapies.

Rachel Rulinantham as PPA, I move to approve removing the 25 visit cap, but applying a threshold for medical necessity review at the 25th visit for speech therapy as is applied for other medically necessary necessary therapies.

Lee Ann OE3, I second.

All right, any further discussion?

Seeing none, we're gonna have to do an oral vote.

So I need um an I or nay vote.

Aye.

Aye.

Do you have that, Casey?

Okay.

Okay, so we do have it passing unanimously for those who are present.

Next item is number seven.

Are there any requests for future agenda items?

No, none right now.

Okay.

Uh then we have eight announcements from staff and can meet committee members.

Uh my announcement was going to be that we're gonna have a committee meeting on June 24th about a potential vote, but that is not what we're gonna do.

So uh I'll let you know about a July date, but right now we will work on just communicating with everybody, going out and talking with everybody, uh, and picking a July date that we can get together and meet.

And uh with the hopes that changes would go into effect in January of 2027.

I don't have any other announcements.

Do either of you no there's one more public comment section, right?

You can come up during that.

Yes, and that's actually next.

Public comment.

Um come on up to the podium if you would please.

Uh Lee Leighton for the record.

Uh I I was been part of this committee for probably since shortly after I retired in 2004.

And uh which is a long time, and what I'm really here to say is this is probably gonna be my last meeting.

Uh I think it's time some new people come in and start taking over.

Uh one of the things that really motivated me to do this is the new format.

I'm just real not real comfortable.

I don't I just don't think there's a lot of feedback.

I don't think there's ways to the dialogue's not gonna be the same.

Uh they've made this uh kind of formal.

I went back and read through the bylaws that presently have not changed.

And the way we did our meetings over there, there was a lot more verbal talking back and forth and feedback between people, particularly the ones that vote.

Uh and I don't see that anymore.

And for me, my time's as valuable as anybody's.

And uh I think you know, if if you do get a new retiree uh to come in, I think that that would be great.

But what I will do is I you know I really appreciate the support that the voting members have given the retirees because we don't get a vote.

And I really think that you've conscientiously have always represented us well in your votes.

You've listened to our issues, and I think it's made a difference.

I I would encourage you to reach out to your retirees, each of the voting members, get lists of your retirees that are on the city's insurance, reach out to them, keep them informed.

That they're not gonna step forward unless they have a complaint.

But see who they are, you know, put out information to them and represent them.

I think the best representation you're gonna have for the retirees are from the voting members because you're voting and you're all on a path to someday be retired.

So whatever you make and the decisions you make, you know, make sure that you think about your future and what you see is best for you and the new people coming in.

But with that, uh, you know, thank you.

It's been it's it's a great committee.

You do a lot of good work.

Yes.

The city's insurance is a great, does a good job.

And you've made some really positive changes to our plan that briefly will have really affected people's lives.

So uh, you know, keep the good work up and thank you.

But this is my official goodbye resignation.

So thank you.

Thank you, Lee.

Do we have any other public comments?

All right.

Seeing none, then we uh have no further business.

The meeting is adjourned at 10 31.