001Good afternoon everyone. Thank you all for being here with us today. This Tuesday, September 2nd, 2025, here at the Dr. Oricardo do Chapa boardroom administration building. At this meeting, there may be discussion by the board on the items and subjects listed as follow. Item number one, call the meeting to order. I've done so at 5:30 p.m. Item two, public comments. We have no public comments today. Item number three, discussion and possible action on approval of self-funded medical plan rates and benefits for 202526. Dr. Gutips. >> Yes. Um, Mr. President and the board of trustees. The district sponsors a self-funded medical and pharmacy plan for its employees. The district works with a benefits consultant to develop and implement a strategic plan with funding and cost control strategies. Mr. Andy Silva, our director for employee benefits and
002safety risk management, will present a report and at the end of the presentation, the administration is requesting approval of this item. So, I'm going to go ahead and turn it over to Mr. Silva to go over the PowerPoint. Mr. Silva uh good evening uh board president uh excuse me trustees superintendent Dr. So yes, uh this evening we're going to be sharing some of the potential strategies that we've talked about in prior meetings and asking you to consider uh approving some of the recommendations that we've discussed. So if I could direct your attention to that first slide there. Uh there's seven strategies that we've talked about before and so I'll go over them briefly and then I'll summarize them in in a slide there uh later on. So the first strategy there was uh for the
003district to budget an additional amount to the health plan fund. So, it was to increase the employer contribution by $55 per employee per month. That actually has already happened. So, for tonight, we're not asking for any action on that item. That's actually was part of the budget uh development process. So, that one's in place. Uh we expect that to generate about $2 million in additional revenue. And as you'll see later in in one of the slides, uh that is still not sufficient to bring us into the black. So that's why some of these other uh recommendations are necessary. Uh strategy number two uh is to increase the employee premiums. Uh this is a strategy that we do model uh almost every year uh just to be uh do our due diligence. Uh it's a strategy
004we're not recommending tonight. A decision was made early on that despite us having it as a potential strategy that we were not going to make that recommendation. We're going to look to see if we can find savings elsewhere to make up any potential revenue that we could have made by uh increasing uh employee premium. So, strategy number two is not one we're recommending here tonight. Uh strategy number three is a standalone discontinuation of one of our three major medical plans. So, we have three plans uh what we call the basic plan, the high plan, and the state plan. And so, we were moving towards a single plan model. So, on a standalone basis. One strategy would be to slowly work our way to that point by discontinuing uh the state plan which is our richest
005plan. However, it also has the highest loss ratios. So, it was one we were uh considering uh discontinuing on a standalone basis. We're not recommending that as a strategy. The reason for that is because we're actually recommending uh strategy number four. Strategy number four is to discontinue not only the state plan but also the high plan and move to a single plan model. Single plan being uh our basic plan. And I'll show you what our current basic plan looks like here in a future slide. And then what the potential uh uh changes to that plan would be in terms of of dollars. Uh that one change potentially could be a $3.5 million impact. So very significant to go to one plan. Uh strategy number five is uh related to number four. So in addition to
006going to one single plan, uh we're recommending making some adjustments to that one single plan. The basic plan adjustments would be a deductible change uh an adjustment to a specialty co-pay, introduction of an impatient hospital copay, and again I'll show you what those look like here in a bit. Uh there was actually four options we had looked at here. Uh we're proposing the more conservative one. Uh potentially it could save 230,000, but we did model all the way up to a $2,000 deductible. So that would be doubling it from the current 1,000 and uh savings of of just shy of a million dollars. Again, that's not something we're recommending uh here tonight. We're recommending the increase by $250 to $1250, which potentially has a savings of 230,000. And again, I'll show you what that looks
007like here in the future slide. Uh number six is also something we're recommending. It's a strategy to create a fourth pharmacy plan uh tier. So currently we have three tiers. Uh each tier co-ay is 750, 25 or $45. So, all drugs fall into one of those three categories, but we do have a lot of medications that are considerably higher than $45, up to $1,000 or even more. And so, one strategy would be to develop uh a specialty plan tier specifically for those drugs. And so, that's what we're presenting here. Uh not only is it very specific, it's very specific to GLP1 medications. So not all specialty drugs which they could be a lot of them just specifically to GLP-1 medications. So that narrows the scope uh lowers the impact to to the members uh reduces
008the number of medications that are potentially fit in that category. Uh that that change potentially could save us uh at a 20% co insurance 185,000 at a 30% co insurance 278,000. So that's something I failed to mention. This tier would not be based on a standard flat co-ay. It'd be based on a co- insurance. And our recommendation is for it to be based on 30% co insurance which is consistent with our medical plan. So our medical plan basic basic plan has a 7030 co insurance. So 70% is paid by the plan 30% is paid by the members. This would be consistent with that. this particular tier 70% will be paid by the plan, 30% will be paid by the member. So that's another one of the recommendation. Number seven here is to implement a 340B
009RX mail program. This is one we talked about also is taking advantage of a federal program to to purchase drugs at a substantial uh lower cost. This one actually rolled out effective yesterday. Uh so we've already implemented this. So we'll be moving into this program uh as our employees respond to the communications and get enrolled and we should be able to get some some savings there. So the next slide kind of summarizes uh these uh recommendations and it shows dollar-wise why is it why it's necessary. So to give you some idea, this fiscal year that just ended, our our fund is going to be in a deficit of about $850,000. And that is with the influx of funds that were deposited into the fund of $3 million. So if we were to do nothing for
010this fiscal year, this plan year, we're looking at potentially a a $4.8 million deficit. So, we need to make some kind of changes. Uh the the first uh change that was made is going to have a $2 million impact. So, that's increasing the employer uh budget and contribution, but we still have some deficit to make up. So, collectively with these plan changes, potentially we'd be in the black uh at a $1.3 million. So, it is something we need to do. uh the district can't be in a position to fund from fund balance you know uh every year certainly not to these levels so it is something that that we need to consider. Okay if we can go to the next slide please. So this is for reference uh these are the three plans that exist
011currently. So basic high and state from left to right. Uh it shows the current uh deductibles for both individual and family current out of pocket for individual and family. uh some some of the office visit co-pays and the pharmacy uh drug copays. As you can see, they're all consistent across the board uh regardless of the plan at 7 750 25 and 45. And there you have the costs. Again, this this is for reference as we go into the next slide. So this summarizes the recommendation. So that middle column there, current that's the basic plan as it exists currently. What we're proposing is to move to one plan that being the basic plan with the additional revisions noted in yellow. So under the proposed column you'll see that the in network deductible uh would go to
0121250 from a th00and uh the that's for individual. The family deductible would go from 3,000 to 3750. There's some uh comparable consistent out of network uh changes that would occur also. Uh, and then in the out- of-pocket area, the individual would go from 5,000 to 5,500. The family would go from 14,700 to 15,000. They'd be a specialist co-pay adjustment of from 30 to 40, so $10. There'll be a new inpatient hospital co-pay of $300. And then the addition of a fourth uh pharmacy copay tier as I mentioned earlier specialty specifically for GLP1 drugs and that would be 30% of the cost uh in co insurance. So that summarizes the changes. There's a couple of reference documents in in the following slides that you might want to look at as we discuss this. But that concludes
013my presentation and we are looking for uh the board to take action on these recommendations. Okay, Andy, you mind if I ask a question? I want to ask a question on the the fourth tier for prescription drugs. How many of our um sorry, how many of our employees are on GLP1? So, what percentage of our >> So, when we first looked at it, and I I haven't noted there there was about 142 on the drug that we were focusing on that was mjro. Uh that was the drug that uh we were seeing the most uh new prescrib new uh utilizers. Uh it it's a very expensive drug. We could not source it at a lower cost than uh than we were getting domestically internationally. Uh wasn't more advantageous and that was two I believe at
014the time. Let me reference that. >> Okay. So I'm just going to do just very simple math. the the cost savings of 278,000,000 divided by 102 that would potentially impose a $2,700 cost on each of these employees that they would have to pay out of pocket. >> So I I guess and and I haven't done the math. >> I mean that's obviously that's just very simple math to first with each. >> So So you are correct that for every prescription now they'd be looking at up to $300 per prescription. Now, what I will say is that >> Oh, it's only there's a max on percription. >> It's a it's a co- insurance. So, if the if the drug's about $1,000, the co insurance would be about three 300 and some odd dollars. So, that would
015be their their portion. Okay. >> So, per prescription. Uh so, uh but not all employees would have to pay that amount. And I say that because there's programs out there uh to reduce that cost, manufacture programs. and we working with our administrator for our pharmacy plan would will try and leverage those uh to make sure that those employees have access to those. Classic example, this past weekend, somebody sent me a message that they got a coupon at the pharmacy they never seen before. It was for a GP1 medication. They didn't have to ask for it. Pharmacy automatically applied it. So there's programs out there so that the cost will be reduced from what the medical plan benefit is. So while there might be several hundred employees enrolled in these uh uh taking these prescriptions, they
016may not all have to pay a co insurance amount. The other thing to consider is that what we're doing here is developing a tier, separate tier. Uh in theory, it's a buyup tier. there's drugs that are much lower cost for the same u indications that the standard co-pays would apply. So that would be working with your physician to see if one of the others is more appropriate. If it is, they have options to potentially uh pay zero because some of those drugs have uh programs where they don't have to pay a thing uh because we're directing them to very specialized sources whether it be international uh domestic specialty where we found the cost to be lower. When we identify those sources, we put in programs where to switch uh to get them to switch there
017is no cost. So, I say that uh I guess to to try and and uh explain that not everybody potentially would be subject to those co insuranceances. Can I tell you that nobody will? That I can't say because potentially some some will. And I guess I have the same question with the impatient hospital stay a 30% co insurance that that can be a massive um financial burden on our employees. How much is that specific? >> So if I could uh by your question there's probably some confusion on how it's written. However, you're on the right track. So it's an inpatient co-pay then services are at 30%. That exists right now. you're in the hospital, you have a co insurance of 30%. That that's existing currently. What we're doing is adding an inpatient co-pay. So right
018now there one doesn't exist. So you go to the ER, there's a $200 co-pay. If you're admitted, it was waved. So if you're admitted, you don't have to pay that $200. If you exit the emergency room because it was something that didn't require impatient stay, you're subject to $200. This adds $300 instead of the $200 if you're admitted. So $200 it'll be waved technically, but you're subject to $100 more because you were uh admitted. So $300. The co insurance that you see on that note that exists already. That's not new. It's only that $300. >> That would be a deterrent to somebody going to the hospital if they needed to go. >> So again, that that exists currently. So it's changing it by $100 in essence. >> So you're saying we're we're essentially because I
019mean there's very few direct admits to hospital. They mostly come to the ER. So you're saying for the most patients that get admitted to the hospital, it's a just additional $100 charge >> from current. Yes. >> But to trust Sophia's point, I mean, is that penalizing patients who actually had an emergency? My sorry my read is that no it's not because the emergency room admittance fee is essentially the same but it's $100 more >> if you're admitted to inatient right so I'm saying like if you go to the ER and you don't have an emergency situation it's an outpatient you'll be discharged but if you do have an emergency situation and they need to admit you we're going to tack on $100 to your bill and it's an emergency situation. So, is that person supposed
020to up and leave and say, "I don't have an extra hundred bucks this month and I'm just going to go home." >> Like, it's kind of not fair. >> How much savings is that then? It's just the the $300. >> Yeah. So, that's on the schedule collectively with those with those three changes, the inpatient, the deductible change, and the uh specialist adjustment. That is an estimated savings of 230,000 >> just the impatient portion >> collectively we we didn't model them separately. So those three changes collected >> like initially you talked you were talking about I think it was family deductibles um one went up from 1,200 to 1250 one went up from 3,000 to 3750 um for a family it was like I mean every single item almost went up Copay went up 10 bucks.
021Everything on this plan went up. >> No, just just those few items there. There's a lot more benefits that are not listed here. The these are typically what you put in a summary. Uh X-rays, you know, labs there. There's, you know, chiropractic care, all those kinds of things. A bunch of other summaries. These are like the the the the most frequently listed on on plan summaries. >> Can I ask um I guess the vendor that we chose and voted on for our insurance? How many years prior have they held this contract? >> I'm sorry, I don't understand the question. >> Um whoever it is that we chose for our insurance So they have >> the new group >> that we just voted. >> This is completely new. >> Yes. >> It has not been finalized.
022>> They're the plan administr. >> So I guess I'm talking Roger Garza. >> Oh, that's a consultant. >> How long has he been with? >> Probably. I mean, that's where my my concern is like starting from slide one, like we're in the hole and yet again we're using the same consultant. >> Um, and now because we continue to go this route, our employees are are basically footing the bill. So, I know I' I've made those comments before about this. I had concerns early on and this board decided to continue. So I I just don't see what incentives we have for our consultant to find a plan that works for specifically our demographic. >> Here we are. Here we are. >> When was the last time that the plans How long have these plans been in
023place? The current plans? Uh how many years has it been years? >> Yes. Uh in terms of rates, the last rate change was 11 123. prior to that >> in 2023 >> 2023 effective 1123 there was one change prior to that and that that was a I didn't present it this time but that was a slide I had previously uh shown the board show the history >> the 2023 had one change to the plan >> it didn't have any changes to the benefits it only changed the rates the rates uh we went back and looked probably at at At least through 2006, we can't find that we did benefit plan changes. >> The the benefits have been consistent. The changes we have made either to employer contributions and at least on on three occasions in
024the last 15 years uh employee rate adjustments. But in terms of employee uh and benefit plan design changes, there hasn't been. And that's and that's typically uh because as you can see here, some of the the impacts there there's some dollar savings but uh they're not they're not all that significant. So decisions were made that okay well we'll see what happens next year. We'll see what happened next year. We'll see what that kind of approach and so we wouldn't make benefit plan decisions uh very often. We hadn't made them in in several years. >> Yeah. 1123 that's basically before 95% of this board was here. I don't know. I just don't know what the solution is. >> Well, I think you know, one thing we're not looking at here is whether it's um negotiations with
025and that's why, you know, we picked United Healthcare. I think we're going from Blue Cross Blue Shield potentially to United is what negotiation power do they have with all the providers? Because this is where all our money is going. And Andy, you and I have talked about this, whether it's direct contracting, um, preferred provider, you know, a tiered plan where, you know, if one provider, high quality provides us better rates, you know, we, you know, steer our pay our employees that way. So, it's a lower cost to the plan. Um, and whatever that might be. But I think, you know, Andy needs to have those conversations with our plan to say, y'all need to start helping us control these costs, not just administer your negotiating rates. here in the community and get that done >>
026because that's where that's why we have shortfalls. >> So what we're having to look at is how to impose the cost on our employees unfortunately. >> So two comments on that. So as far as United Healthcare uh this uh recommendations this modeling was done under the assumption of Blue Cross Blue Shield we don't have any data yet we can turn to and say oh yeah United Healthcare is going to help us this much so that we can adjust accordingly that'll come in the next year so come this time next year when I have to present to you any changes uh I'll have that information to say oh United Healthcare with United Healthcare the claim cost drop this much you know we don't have to fund as much so that that will be built into the
027next evaluation uh similarly uh in terms of having discussions healthcare uh this going to one model puts us in a position to have potentially a new plan such as you just described once we get in with United Healthcare and have them work with us develop a plan that has more advantageous uh discounts at a particular hospital or hospital systems and we can develop a tier uh network, a certain plan that's more advantageous to us and to our employees. And we move into a two plan tier uh from a one plan one year to a two two plan the following year. The reason that's not here now is because we didn't have an opportunity to have those discussions with with the new group. We're just now getting started with them. Uh that doesn't happen until January
0281st. Uh and this plan year it it starts January 1st. >> So for almost a whole year our employees will have to pay more out of pocket >> based on on these potentially pay more out of pocket because uh these are uh recommendations that uh potentially there'll be greater out of pocket cost uh if you're utilizing the plan. If if you're one of those employees that has routine office visits primarily, you're not in a GLP1 medication, you won't see much of an impact. If on the other hand, you have hospitalizations often or an emergency hospitalization, yes, that you'll see additional out-of- pocket expense compared to what they see now. But um this is not is this an issue that's that you know we're voicing some concerns here that's unique to our district or is it
029this like like what I'm hearing it deductibles are going up everywhere. >> It's definitely not unique to our district. >> Like how reflective I mean I'm not trying to >> I'm just wondering how much is just our economy that we're in and what we're seeing. So, so and Miss got to see us coming to that. That that shows you comparatively how how we are current to other school districts. Uh we're not all aligned. Not all deductibles are the same. Not all out of pockets, but we all struggle with the same things. And the levers we can pull are benefit design changes. They are increasing rates, increasing employer contributions, all those kinds of things all at once or separately. Uh but all these school districts, I can assure you, struggle with these same kinds of things
030every year. They just handle them individually, you know, however their administration and their board uh feels comfortable. >> So what I'm sorry, >> no, I'm done. Um what were to happen if we don't approve this today? >> So what's the alternative? >> Sure. So, if we don't approve them and the direction is we make no changes, potentially be in in a pretty significant uh deficit next at the end of this fiscal year based on the projections. If if United helps us in terms of lower claim costs, well, that deficit might be considerably reduced. That at this point, I I couldn't tell you. Uh if the direction is to come with something different, we can't. I just need some direction on what kinds of things you would consider. >> There are that we can't control. I'd
031like for Andy to give you all an update on our high cost an unusual amount. >> So in in a span of uh two days, I I typically get notifications currently from Blue Cross of what's considered a high cost claiming that that's a claim that has hit a hospital typically uh exceeding $80,000. U I usually you know, one or two or three a month and they could range, you know, 100,000 here, 200,000 there. Uh, in a span of one weekend, Friday and Monday have five notices that collectively was, uh, $3.5 million on five claims. So, that contributes to where we're at now. Whether that be different with United Healthcare, I couldn't say. Uh potentially, it depends on what hospital system, depends on what the situation was. Uh all of those are variables. Um I'm trying
032to wrap my head around all of this. This is very new for me. So please forgive me if I'm asking some basic questions. For historical perspective, if our projection for 2526 is a $4.8 million in the red, how does that compare to, let's say, the past three years? >> So, this this past year, we had anticipated $800,000 in the deficit, and that's that's where we landed. >> Uh, prior to that, we actually had a positive fund balance of about $69,000. uh in both of those years there was additional funds that had to be uh uh transferred in. So while we managed to manage reasonably well, it wasn't without help. Uh had it not been for those additional funds, they they would be in the deficit as well. Uh and again, that's a function of a
033process every year. How much money is available >> for raises, for health plan adjustments, and decisions have to be made. Y >> uh so a decision could be made to leave the health fun uh budget alone potentially we're going to need some help during the year at the end of the year and so uh it's been some very tough last couple of years >> but it seems to me with that said that the 2526 projection is an outlier above and beyond what the past two priors have been >> it it is I would say yes and an outlier but it's based on overall trend going back several Yeah. >> Compound did infuse $3 million this past year in addition to the 800,000 $850,000 deficit that we're going to add. >> So, it's really >> uh
034that's helpful. Yeah. And that's 3 million above the $55 increase per employee per month employer contribution. >> Okay, that's very helpful. >> Yes. A little uh I guess background for those of you that weren't here. That was a decision that was made >> before the last budget cycle that we're going to hold hold the employer contributions. We're going to hold the employee rates with the understanding uh we're probably going to need some additional money >> this last and and that's how it worked out. Uh it it was it was predicted projected it was going to be a deficit and it turned out to be a deficit. Yep. even with the additional funding that was uh was >> yeah thank you um and thank you Dr. Canales and Mr. over for the conversation earlier. I'll just
035share here where my concern currently lies and it's a combination of what's in attachment C and attachment D. And I actually think the information that's shown on attachment D is obviously an increase in some pretty significant areas, but it's only currently showing the sidebyside for somebody that's on the basic plan today and would be on the basic plan on 11 126. My concern is the roughly 600 or so employees and families that are on the high plan today or the state plan today, which is one out of every six of our employees who'd be seeing a pretty significantly different change in their benefits and coverages and most specifically in the out-of- pocket maximums. Right? So, let's say an individual is currently on the high plan. We'll just throw the basic out or the state plan
036out for now because it's a relatively small number of folks. The difference in the out-of- pocket maximum accounting for the savings that they might have on a monthly basis is $2,300 at the individual level. And the savings at the family level of out of pocket or excuse me, $1,000. Um, and a family that's on the high plan currently, an employee with their family, out-of- pocket maximum is going to increase by over $2,200. Um, and my mind goes to the families that have chronic illnesses or that on an annual basis are definitely going to hit their out-ofpocket maximum. That $2,200 feels like a lot. Um, and I recognize we've got to figure out a way to make this whole, but when I go back to the balance sheet on attachment B, it's hard for me to
037to feel like this suite of proposals is the right step when we actually end up $1.3 million in the black. Now, I understand that on an annual basis things change and we don't want to cut it too close to even in recognition that on a given weekend we might get hit with five highcost claims like you just described. But to me that feels a little bit high given the amounts that we've heard in terms of where we've been over the course of the past couple years. >> I'll just make one comment to that. uh unlike what the business office has to deal with on a a recommended or or required fund balance, we do not have one for this specific fund. >> Yeah. >> But uh we've developed a strategy and it does it does
038change. It's it's a percent of our liability, a percent of our claims over a three-month period, uh pharmacy and and medical. The number of an ideal fund balance for a fund like ours u the last figure I have is about $6 million. That's where we should be on a regular basis. >> So 1.2 1.3 while it might be a lot looking at it here. >> Yeah, >> it's still considerably lower than really where we should be. And the reason it needs to be higher is for those shock claims, those things that happen unexpected uh beyond our control. Uh we need to be able to fund. >> Yeah. So a follow up on that. Is it fair to assume that right now the fund balance in the insurance fund is zero if we're running in the
039red? >> It's in the red 800 48,000. >> Yeah. Okay. Thank you for that additional information. Andy, >> sorry. >> I two questions. One, I guess to put in perspective because we're talking about the deficits, but what is the plan spend in 25 26? Well, I guess we don't have that yet, but in 2425 and in the past three years, what did the plan pay out? Has it gone increasingly high or did we just have did we just eat up any positive balance we had? >> You mean total expenses from from that standpoint? I I have that number. Uh we landed at 28 million >> at 28 million. >> 28. We're projecting 30 million for for next year. A $2 million increase. >> And then on to Trusty Garion's point, is it legally allowed? Can
040we keep the state plan and freeze enrollment whoever's in it now? And then, you know, just let it >> because I I assume that most of the families in there are in there for a reason that they have high medical costs or there's a reason they're on the state plan. >> I'm I'm going to defer that one. Uh kind of put legal on the spot. I think we can we can we can close uh enrollment. It it'd be like a plan that's sunsetting. Uh that's something I can look into. I don't have an answer for you right now because that's not something we we consider or that I researched >> is that on option three attachment A, >> you know, discontinued state plan that saves us $500,000. So presumably that would add $500,00. >> Yeah,
041>> I'm assuming we could >> because we own it. >> Defer you're going to need to give me two days to do some homework on that to make sure I'm confident we can because our plan doesn't >> do we own the plan and so I think it's dual but you can check on that but but it's a >> it's something that uh these plans are our own plans they're self-funded um you know all our all our funds is because of employee contributions to the plans and that's how we are able to have our self-insured uh program. Uh I know it's not an easy decision, but uh if we don't make changes then then we will continue to bring budget amendments to take money from fund balance to cover the medical cost. And that's what we've
042been doing for the last year to now. We want to see how we can uh right now it looks like for for every dollar that we put in as employees, three are going out. And that's what the problem is. We need to put it where $5 go into the plan but $3 go out so that we can sustain a fund balance and and maintain the the cost where we're not in the red and and so at some point we have to make some adjustments to the plan unless we want to continue dipping into fund balance and bring you budget amendments we can do that and leave the plans alone. Uh but if you look at our plans uh in comparison to the state plans, Andy, you you're more familiar with the smaller districts have the
043state plan with TRS active care. You you ought to see their rates. They're through the roof. >> 70% I think. >> And but because we're selfunded, we have a very good plan. And even these changes are very still are still puts us in a very good plan. It doesn't put us in a very expensive plan. It puts us in a very good plan to to sustain it because we are the ones that own the plan, we are the ones that finance the plan and so if our employees cannot sustain it, then we have to get it out of fund balance. It's >> so that's where we are. >> May I interrupt? Um Mr. Silva, um so you're using the GOP ones as one of the more expensive uh option or reasons why the plan is
044so expensive, right? I don't know how many people we have on GOP once, but I'm going to use myself an as an example. I have lupus and an array of secondary conditions. Just today, I was at the doctor and I had four of my meds changed and the cost is going to be crazy because at least three of them are really expensive and even with my co-ay and everything. Um, how does this impact someone like me? because we're just concentrating on you had a weekend with five high claims and you have the GLP ones. What about someone with me has a chronic condition that I mean you all see the band-aids every week and they rotate fingers, but how does that impact someone like me out of pocket? So, so I guess generally speaking in
045terms of the medications, if if in your uh list of medications is not a GLP1, that part wouldn't impact you at all because this is specifically to GLP1s. So, unless you get prescribed a GLP-1, you wouldn't be subject to this particular change. As far as other uh visits, if it's a specialist, you'd go from a a $30 coh copay to a $40 copay every time you go see a specialist. So that's a $10 change for each one of those visits. Uh similarly, if if using the example of going into the hospital, so if it was an emergency and you were not admitted, well then that additional $100 doesn't apply. If you're admitted, then it's a $300. >> How fair is that? because I think that we have more more um employees that have issues like
046mine than we do the GOP ones. It's not fair. >> And and I'm going to say this without trying to be insensitive. Uh the majority of the utilization is a small percent. So it's it's being funded by a majority of those that aren't having the expenses. So, how fair is that? >> It's not fair all the way around. >> That's why I wanted to have it just to focus on this item because it is it is critical what uh we have. Um what I'm reading from the board is maybe we're not ready to make a decision. Let us go back and see other other possibilities. If you want us to look at some other numbers and and look and look at other maybe ways that we can bring it back. But at some point we
047got to do some changes to some some items. But maybe u we can go back and look at it with our consultant and uh and review some more numbers where it's not as impactful to the employees as as we're talking about. But that there might be some changes. I can't wrap my head around someone who has a chronic condition more likely than not will end up in a hospital having to pay more $100 more $100 more every time. You know, I I can't see p it's I shouldn't say punishing, but tacking that on to people who my condition is for life. My condition hasn't periods where it's dormant. But when it's active, and it's active right now, I'm at the doctor every week. I could or could not end up in the hospital today or
048Friday or next week, and I'm going to have to pay a hundred bucks more. That's kind of not fair. That's why I feel like this sticking to one plan and not having options for people who have more serious things because I know that if you have a doctor that you can talk into giving you a GLP1 to lose weight, you're going to get a GLP1. That was my question. And that's not hard to do. >> So, we we have controls for that. There's there's at least four four things that have to be met. One uh it's the A1C number. There's a standard you have to have that obviously a diabetic diagnosis and there's a couple others that I can't recite off the top of my head but uh if if there isn't those four things
049then it's not approved I guess >> so then we don't cover that bound that's the >> is that strictly for weight loss >> that's the mjaro for for weight loss >> then we do not we do not cover weight loss medications our plan does not cover >> and and I have to say >> they're made by the same >> my apologies to any out there that's listening. I'm not saying doctors are um easily persuaded, but there is a doctor or two out there. I know somebody who's pre-diabetic on a GLP1. I mean, you know, that's I feel like how many do you know? You said it's like 200 and some people that are doing the >> It was 102 when we did this analysis the last time that that were not on the full GLP
050ones that were on the Mjo that we were targeting. So 102 people, but people like me are going to get something tacked on because >> 112 people on GOP ones and this is why we're talking about this today. And again, I'm not I'm not talking about people who um have diabetes. I have a brother that's got diabetes and he goes through an array of stuff, too. But for people who have the long-term chronic conditions that more than likely will end up in a hospital, um they're the ones that get that extra charge. So I I'm not ready to make a decision. >> On the if I may, on the GOP one, may I sir? Joe, the the other thing that a plan like this would do for us, it in in some form future proofs
051our plan because uh for those of you that that have tracked or are familiar, uh Mjo is like the latest and greatest, but there was some that preceded it. So, uh as new drugs are coming on the market, they're more and more expensive. Uh we we had a huge uh increase in cost when Trulicity came. We didn't have any controls. It was subject to the same 25 or $45 co. Then that faded away when omp came and that faded away when came. So there's going to be another drug after that and another drug after that. And they're going to be more and more expensive. So >> how does it foolproof our future plans? It it puts us in a position if if we set it up as I described, GLP1s that we don't know about
052today will be subject to this co insurance six months from now, a year from now when a new drug comes out on the market. It's already subject to this separate uh co-ay. I just had one other question to the sort of options on the table. Obviously Andy, you and the team have put together a lot of work to bring us these seven potential options with 1, two, three, four, five recommendations that you were proposing tonight. Were there any sort of options that were cut early that didn't make it to this that would potentially be up for reconsideration at this point? >> So, one of the ones I just mentioned was cut early and it's one we looked at every year and unless we would we would make a significant percent increase would be to raise
053the employee premiums more contribution. >> Yeah. So, you know, we only have, like I said, so many levers. We we can adjust uh benefits or revenue contributions. Y >> uh cost containment strategies, we definitely look at those uh th those on the back end, you know, the pre-authorization, those kinds of steps to make sure things are medically necessary. Those we count on our TPA to to manage those. We don't factor those into these uh types of recommendations. So, uh, that was a long answer to say no. There wasn't a whole lot of other things we we looked at. It's benefit plan design, rates, and funding. >> Yep. That's helpful. Thank you. And and just to again like get super clear and um we were looking at I'm looking at attachment B of the options. It
054seems like option one and option four in terms of the proposals are musthaves if we wanted to get out of the red and into the black. And the others help us start to build that fund balance to the desirable level. But there's no way for us to even be out of the red and into the black if we don't do both one and four. >> So, so one is already done as a budget process. We're going to start getting additional contribution already. >> Thank you. >> Uh but yes, uh the other one that has the pretty significant impact was going to a single plan model. And and just as an additional information, why would this be additional cost savings? Exactly what we've been discussing right now. It has lower benefits than the other two plans.
055So there's a co insurance that goes to the employees that the plan doesn't have to pay. That plan right now is the one that's more appropriately funded for the benefits. So the amount of contributions between the district and the employee, it's keeping that fund in the black for the amount of of claims that are being paid because the benefit ratio, benefit uh to to revenue ratio, all those things are aligned about where they should be. The other two, they are not >> to to rightsize those those rates would have to go through the roof manifold. >> And that's something that we would never bring to you because they're not realistic. >> Yeah. Thank you. And I want to ask you one question on the I guess the question I had earlier about freezing the state
056plan or sunsetting it. Would that be fair to other employees would not be able to enroll in it. So judging by some of the sentiments, no that if the sentiment is that we we need plans options because employees have different needs, uh then we'll be somehow isolating some people potentially from not having access to those richer benefits. Okay. Um, well, any further discussion, further comments, >> you want us to look at it some other ways to bring you something else and let us know, we can do that, too. I mean I know that these are not easy decisions but our health plan is to be balanced out also but if we go back and you know bring you some recommendations we still have to uh be in agreement that there will be some changes that
057we're going to have to do anyways is just let us look it over and see what we can bring back to you with the understanding that there will be changes that we need to make. maybe not as like this but some type of a changes to the plans that that we need to do. >> By when do you need >> um we could have it sometime in se towards the end of September. We still have so so I would say no later than the end of September. And the reason I say that is because we'd like to have three things ironed out for our open enrollment period. It's who our third party administrators will be so that we can make sure that they're aware during open enrollment that things are changing, new ID cards, those
058kinds of things. Uh if rates are changing or not, you know, that that's what we want to make sure our employees are aware. Uh and then obviously any any benefit plan design changes that all happen. All that information needs to be in their hands on or about the enrollment period. I can probably move the enrollment late October, early November. That gives us a little more time but we don't have a whole lot of time. Uh now the other thing I would mention this is a one one uh effective date for these changes if any changes are made but decisions have to be made a little earlier than that so that we can make sure our employees are aware of what's changing or what's not changing. I would say by the end of the September no
059later than the end of September to bring you some some other ideas that we would have but with the agreement that we need to make some changes. We got to make some changes to plan and be able to uh selfund it. >> My my take on this is this is all a lot at once that was brought and it's what's needed for the sustainability of the district in the future. Um I with my fellow trustees that are there saying well it's can be a shock to the employees. Maybe finding a tiered approach as trustee had brought in would be something to to look at. Uh, realistically speaking, I'm I'm seeing it and I know it's something in the future that the district's going to have to do. If you look at Dr. Gutierz had mentioned
060TRS active >> active. >> So, they're at a position to where I think employees that are on that plan, right? The other districts are paying 70%. compared to the 30% >> TS active care. Uh it's primarily even though it's open to larger school districts, it's primarily the smaller school districts that jumped in. Uh and I think they're finding themselves in in they actually want to step out and now they can. >> Why would they do that though? If you're a smaller district, of course, smaller revenues, smaller budgets, why would you go into a plan that's going to significantly increase costs for your >> I I can't speak for them. I can only speculate that that they had visions that it was going to be managed and keep cost low and benefits reasonable and it takes
061the administration away from them. So it was more of all we have to fund is whatever uh is is stipulated but they they see adjustments all the time uh not only their benefits but the rates as well and they have no control. U we're in the situation where we have that control but we have to make these you know very tough decisions. >> What what we can do is uh since we got United now and Aria we can sit with them and talk to them about how they can help us maybe offset some of this cost and bring a a minimal changes and and with perhaps some some savings that they can give us since they're going to start with uh well we already have a riot but uh United that uh maybe we can
062get some uh better savings or better that they can work for us with us and then bring you some some changes but not as this kind of changes but some type of changes that are more minimal. >> I think at minimum United Healthcare could come to the table and say we're going to help you with this. >> Yeah. >> And I'd really like if you could you know have those discussions with them and kind of bring back a few more recommendations or at least some u some kind of agreement on their part that they'll help. Um this is this is a big decision for our people especially pe our our staff that has had options. You're going to one plan going to one basic plan and that's hard for people who have been like I
063have a high plan. I have an option of a basic plan and a high plan. I of course have to buy into the high plan because of everything that's going on. and at least I have that option because it gives me better coverage and more opportunities to be able to take care of myself. So, we're moving to one plan. I think it we have a little bit of more help or at least some recommendations from uh United Healthcare. It would help our employees to be able to plan, you know, because they're going to get one plan put in their in front of them when it's enrollment time and that's hard when you've got other issues to deal with. That's at least what I would like to see. United Healthcare can come to the table with
064some help. >> We'll we'll work on that and see what >> it's the will of the board, but that would be make me feel a little bit better. >> That that was the original plan anyway to obviously have those kinds of discussions early on. Uh we we'll have to see what uh leeway I'm given to start those without having a contract in place. And you know, because we'd want to share data with them uh so they can model things for us. I don't know how quickly they'd be prepared to start doing that, but uh >> I think they're they want the contract. >> We need to have that signed. >> They should they should be able to talk to us about what they can do. You know, that's that shouldn't be or I don't know
065how much I can talk to them about without a contract. They want the contract. They should be at the table. >> I think the board is pretty open for us to have those discussions so that we >> because in the essence of time we we don't have a lot of time. We only have this month. >> Well, it's day two of this month. >> So, there you go. >> Andy, are there Sorry. Are there supplemental health plans we can offer employees that have a lot I guess of usage? >> So, so we offer supplemental health plans already for hospitalization and for accident. Uh those are on the voluntary side. Uh participation is not as big as some of those others. Uh like our disability for example, I have a lot of enrollment in that. Uh
066cancer plans, standalone cancer plans, a lot of enrollment. Uh not so much in those uh med gap type programs that help you offset some of the health plan related out-of- pocket expenses. >> Okay. So we do actually offer some >> we do two different types. >> Okay. Well, um >> what would be the motion here to No action. >> I'd like to move that we take no action on you proceed as correct. >> Okay. I have a motion by trustee PÑA to take no action and proceed as discussed. Do I have a second? >> I'll second. >> I have a second by trustee Hadad. All in favor? >> I. >> All opposed. Okay. Motion passes. 70. >> Thank you. All right. Thank you guys. And now I need a motion to adjurnn. >> So move.
067>> Okay. >> Second. >> All right. I have motion and a second. All in favor? >> I. All >> oppose. Motion passes 70. We're adjourned at 6:28 p.m. Thank you guys.