[1:00:00] taking advantage of out-of-network benefits today,

[1:00:03] 270 on the hybrid plan. That is not

[1:00:09] a cross-accumulation issue, but the 357 individuals

[1:00:13] on the consumer choice ICE plan would be impacted if

[1:00:19] we were to move forward with removing that cross-accumulation,

[1:00:23] which is the recommendation of MJ.

[1:00:34] Not seeing any questions. We can keep going. Okay. Thank you,

[1:00:37] Jamie. And I think just to put a bow on this one, the The

[1:00:42] plan would still have out-of-network coverage. Members can still

[1:00:46] go out of network just like they do today. The only change is

[1:00:49] that they have to satisfy separate deductibles and separate out-of-pocket maximums,

[1:00:53] whereas today they get— they can kind of blend the two.

[1:00:56] Honestly, it's about equity between the plans more than anything else.

[1:01:00] There's a lot of risk and a lot of exposure that Jamie touched on,

[1:01:03] but it's really about, in our isolated MJ opinion,

[1:01:07] treating the same— treating members on both plans the same. But that's

[1:01:12] my takeaway. All right,

[1:01:15] one more final BAB recommendation before we move on to

[1:01:19] premiums, and this one's over to Andrea. Yes, thank you.

[1:01:23] This is Andrea Crone again from the MJ Companies. So, as I noted

[1:01:27] earlier, the MindCo utilization— so, again,

[1:01:31] to Commissioner Stoltzman's question earlier, really utilization,

[1:01:35] who's actually using the program and engaging in it.

[1:01:38] Using the app is, is far below what is needed for those programs to

[1:01:42] really have a meaningful impact for your employees. I will add really quickly,

[1:01:46] and I should have said this before, the BAB members did also seek

[1:01:50] feedback from each of their departments on MindCo, if they

[1:01:54] had used it, what their feedback was. And, and to your point exactly,

[1:01:58] Commissioner Stoltzman, there was feedback around, I've used it,

[1:02:01] but I was dissatisfied with the app, or the headset didn't work, or it was

[1:02:04] uncomfortable, or I didn't want another app. So there was some, some relevant

[1:02:09] feedback there. Um, the county does have alternative

[1:02:13] stress relief and tobacco cessation support that's already available through

[1:02:17] programs that you have in place. So, for example, through your employee assistance

[1:02:21] program with CareLink, um, your medical and pharmacy plans can help treat

[1:02:25] mental health and stress disorders as well as prescribe medications as

[1:02:29] needed. And then you also do have a wellness program that's already in

[1:02:32] place that that offer support for these specific types of services.

[1:02:36] So with that information in mind, both the BAB and MJ recommend terminating

[1:02:40] this program for 2027. This will result in about $110,000

[1:02:46] per year in savings for the county. And really where that comes in is MindCo

[1:02:50] charges a per employee per month fee for every eligible

[1:02:54] employee, regardless of whether they are using the program. And so

[1:02:58] again, with such low utilization maybe around 8 or so people

[1:03:01] per year using each of these programs, but you're still paying for

[1:03:06] the full population to have access. And for your consideration,

[1:03:10] we have included some additional information about this recommendation in

[1:03:13] the appendix.

[1:03:19] Thank you. All right,

[1:03:24] Kyle. All right, Kyle Sullivan here to talk a little bit about

[1:03:29] what the employee premiums might look like. So as Andrea mentioned, we did have— the

[1:03:33] BAB did survey their members

[1:03:38] and the members they represented, and one of the things they came back with

[1:03:42] is they wanted to ensure that there's a balanced approach to managing costs. So not

[1:03:46] only looking at changing the benefit design, but also considering changes to

[1:03:51] the employee premium premiums that come out of their paychecks.

[1:03:55] During the BAB session, they recommended shifting an additional

[1:03:59] 1% of employee premium cost share to employees

[1:04:03] in a way— or in an effort to help manage

[1:04:06] and reduce the cost increase to the county.

[1:04:12] Both of the scenarios that we'll look at here will show a status quo scenario,

[1:04:16] and then we'll discuss the two proposed scenarios. So just to set the

[1:04:20] baseline, the status quo scenario based on our current cost share has the

[1:04:25] $36.9 million total broken

[1:04:29] into the county portion and the employee portion. So the employee portion

[1:04:33] is currently 13.3% of the total annual

[1:04:37] plan spend, and the county portion is 86.7%.

[1:04:44] If we look at what that cost shift looks like, like combined

[1:04:48] with the plan design savings in each scenario,

[1:04:53] the 14.3% with the BABB recommended

[1:04:56] scenario has the total costs that have been reduced by $600,000.

[1:05:00] So the $36.3 million split into 14.3%

[1:05:06] of the total covered by employees,

[1:05:09] that would be an increase of about $300,000

[1:05:13] from an employee cost basis.

[1:05:17] With the additional savings and the additional $400,000

[1:05:22] savings in the MJ recommended scenario, that cost increase is

[1:05:26] reduced by about $60,000 to employees,

[1:05:29] and the employee cost share again is the 14.3%.

[1:05:33] I want to note that these cost shares of either 13%

[1:05:37] or 14% are very competitive among municipalities and

[1:05:41] employers in general. And we'll note on the next slide what

[1:05:44] that actual dollar amount to people's paycheck, the change

[1:05:48] looks like. But I just wanted to comment that it's been important for

[1:05:52] us to ensure that we're aligning with benchmark and ensuring

[1:05:56] that the full benefit package, both from a plan design perspective and

[1:06:00] a payroll deduction perspective, is robust.

[1:06:04] Can we stay on this slide for just a minute? Commissioner Litschman, do you have

[1:06:08] any questions? I do. I just am getting one other piece of information before before

[1:06:10] I can ask mine. Thank you.

[1:06:14] I'm waiting for the slide that shows the breakdown of

[1:06:18] what that costs with the different employees. So, okay.

[1:06:22] Thank you for asking. Are you breaking this down further on the next slide,

[1:06:26] Kyle? Yeah. Yes. The next slide will show the monthly rate. So it will

[1:06:29] absolutely address or help address that. Let's see

[1:06:33] that, and I might have you go back to that last slide also. Sure.

[1:06:37] Perfect. So we want to start on the left here with our current plan design

[1:06:41] offering and our current payroll deduction. So on the top, just orienting,

[1:06:45] we have the Consumer Choice Plan. These are all monthly employee

[1:06:49] deductions based on the plan election and the coverage

[1:06:54] tier election. If we're looking at the middle column,

[1:06:58] this represents the change on a monthly basis based on each scenario.

[1:07:02] As I mentioned, a balanced approach with less plan design changes.

[1:07:06] There is an additional increase, or a slightly higher increase,

[1:07:10] to employee rates. On the Consumer Choice Plan, the monthly

[1:07:14] change is between $16 for employee only and $69 for

[1:07:19] family coverage. In total, we're still looking at a

[1:07:23] little bit over $350 per month for family coverage, which is extremely

[1:07:27] competitive, especially in the current healthcare market

[1:07:32] space and considering

[1:07:35] how much your plan design

[1:07:39] covers is very competitive. From a hybrid plan perspective,

[1:07:42] that increase is higher, so it's $22

[1:07:47] for an employee per month in addition to our current amount and an additional

[1:07:51] $89 for family coverage. Still,

[1:07:55] we're our total family per employee

[1:07:59] per month rate would be less than $500 for your

[1:08:02] buy-up plan offering.

[1:08:06] Do you have a question at this point or do we want to talk?

[1:08:08] Yeah. No, I think I do. So if you could go back to

[1:08:12] the last slide, I think it's a little cleaner of a question on that slide.

[1:08:15] So on the— I

[1:08:20] see that you've tried And the BAB recommendation and your recommendation,

[1:08:24] you're trying to show a similar cost share between the county and

[1:08:28] the employee of the county. And so going back to the plan design that

[1:08:31] drives that, you're essentially trying to

[1:08:35] drive down that cost to the employees and county by increasing the out-of-pocket

[1:08:41] max and reducing the risk. Is that right, Kyle? For the total, yeah.

[1:08:45] So the total amount reduces due to that. And I

[1:08:48] honestly probably should have highlighted the county's portion here because that's one of the really

[1:08:52] key considerations. If we look at the county status quo, we're looking

[1:08:56] at $32.0 million. In the middle column

[1:08:59] with the recommended change in cost sharing and plan design, we're looking at $31.1

[1:09:05] million. So a $900,000 difference. And then in the MJ recommendation,

[1:09:10] we're looking at the $30.8 million. So that's

[1:09:14] a piece I should have mentioned earlier. No, I see that. I'm really focused

[1:09:19] on the employee row, actually. And so it looks like you've tried to keep that

[1:09:22] 14.3 to 85. fixed while using

[1:09:26] the plan design to reduce the risk basically on

[1:09:30] your side. So the risk is essentially getting shifted to employees that may

[1:09:34] experience more sickness, like right in their out-of-pocket max,

[1:09:38] that's where it's made up for. Is that right? Correct. That's what's driving the

[1:09:43] change in the total. All right. So like as far as like who

[1:09:46] benefits and who burdens between the raspberry color and the purple color,

[1:09:50] like the employees that are experiencing more chronic illness or maybe hitting

[1:09:54] their out-of-pocket max are who are being burdened with the purple design?

[1:09:58] Correct. There would be— and then healthier employees are benefiting

[1:10:02] in the raspberry, or I guess healthier employees are benefiting in the purple.

[1:10:07] Yes, from a plan design perspective.

[1:10:10] One of the considerations discussed during the BAB was that there's this interplay

[1:10:14] between if the county is paying more in benefits, that that also might

[1:10:18] reduce the amount of compensation that could be passed on. And so that

[1:10:23] was one of the considerations in the purple is if

[1:10:27] we're able to mitigate cost there, that it might help ensure

[1:10:32] that employee increases are not burdened by additional increases

[1:10:35] from the benefit plan.

[1:10:38] I mean, but you're just positing that because we've not talked about that. So I

[1:10:42] don't have any other questions. Thank you. Thank you.

[1:10:47] Kyle, it's Courtney again. If I could just chime in, I really appreciate Commissioner

[1:10:51] Stoltzman's comments. One analogy I like to use is if you focus

[1:10:55] first on the total, that number gets smaller as we move

[1:10:58] into raspberry and into purple, so that the entire pie gets

[1:11:03] smaller when you change plan design because the dollars, you know,

[1:11:06] the dollars, the cost of the dollars go down. Obviously, the employees have

[1:11:11] to pay more at the time they use care. So that's decision point number 1,

[1:11:14] which was driven by Marathon and the plan design changes, obviously, we've been talking

[1:11:18] about. Step 2 is to then determine how does that pie get divided

[1:11:22] into 2 pieces, the piece the county pays for in premiums versus the piece the

[1:11:25] employee pays for in premiums. And that's driven by this cost share.

[1:11:28] So it's, you know, you'll notice this 1% shift.

[1:11:31] It's 13.3% today. The proposal is for the employees

[1:11:35] to pick up an additional point of the total.

[1:11:39] The total is smaller in these two scenarios,

[1:11:42] and you're absolutely right that it's a bit of a balance between,

[1:11:46] you know, if we've got this pie to split in half,

[1:11:50] you know, raspberry gets you a lower number through,

[1:11:54] gets you lower on plan design. Purple gets you even lower

[1:11:58] on plan design, but you're absolutely right that people who would feel that would be

[1:12:02] the people who use care the most, i.e., being the

[1:12:06] sicker or the folks that just use more care. And that was exactly the

[1:12:10] conversation during the BAB and all that is outlined on the readout in the back.

[1:12:13] So you articulated that perfectly.

[1:12:16] Thank you. Any other questions on the plan design?

[1:12:22] At this time, thank you. Thank you.

[1:12:26] So let's see, next topic.

[1:12:30] Any questions on the rates and the change to the employees either?

[1:12:36] Just in regards to the rates, for me, I think my questions are going

[1:12:40] to come later when we're talking about the actual figures and numbers.

[1:12:43] So I'm holding on to thinking about this

[1:12:48] one. Okay.

[1:12:53] Dental premiums. Dental premiums are very exciting

[1:12:57] this year. There are no changes to dental premiums as we're in

[1:13:01] a rate guarantee. So I'm pleased to present the current

[1:13:05] and 2027 dental premiums and employee deductions.

[1:13:11] Thank you. Vision premiums. Very similar to dental, one of my favorite subjects.

[1:13:15] We're in a great spot for having these rates locked in for another year.

[1:13:19] So no changes to vision premiums.

[1:13:23] Thank you. All right,

[1:13:27] this is Andrea Crone again. Just a quick renewal summary here for

[1:13:31] you. Really, this is highlighting when your programs

[1:13:35] are up for the next round of RFPs. Just wanted

[1:13:38] to highlight that we did complete RFPs this year for life,

[1:13:41] disability, FMLA, and leave administration

[1:13:45] earlier this year, so those have been completed.

[1:13:48] And the RFP panels of course voted to move those

[1:13:51] programs from Lincoln Financial over to Unum for life and

[1:13:55] disability, and then to bring the leave administration

[1:14:00] in-house with a software called PulpStream. We do have

[1:14:04] the stop-loss RFP coming up. That is something that we typically market

[1:14:08] every year just to ensure you're getting the most competitive rates. So that is

[1:14:12] upcoming. And then, of course, the virtual mental health and tobacco

[1:14:16] cessation through MindCo that we do recommend terminating that on

[1:14:20] December 31st, '26.

[1:14:23] And then after that, we do have some additional RFPs coming up next

[1:14:27] year, really high-level, just flexible spending accounts, COBRA administration,

[1:14:31] and identity theft. And then we're, we're good for a little while after that

[1:14:34] on the need for RFPs for these programs.

[1:14:40] Thank you. Before we go to the discussion

[1:14:44] on those topics, just are there any other topics commissioners have that weren't covered

[1:14:48] in the presentation or ready for discussion?

[1:14:53] For me, Commissioner Salzman, I'm really— I

[1:14:56] want to have a discussion with you around the

[1:15:01] recommendations and what I'm wanting to look

[1:15:05] at more specifically what happens if we don't make a change

[1:15:09] on the benefits. What does that mean to our members?

[1:15:13] So if this is the right time to talk about that, that's great. If it's

[1:15:16] later, that's fine too.

[1:15:19] That's great. We will— we can do that right now. I think that I

[1:15:23] wonder if MJ or Budget has any,

[1:15:27] you know, sometimes we see a slide that shows like

[1:15:31] the overall cost of like status quo, overall cost of the BAB recommendation, overall cost

[1:15:36] of the MJ recommendation. I wonder if we have something like that you could take

[1:15:39] us through. Yep. Let me go back to that. Thanks, Courtney. That was 23,

[1:15:44] I think. Oh, nope.

[1:15:48] Oh, boy. Trying to go backwards. This one.

[1:15:51] This is specific to medical because that's the only piece that's changing in cost.

[1:15:55] Everything else is staying the same. So, we're— if you do

[1:15:59] nothing, it's a 36.9% $1 million total

[1:16:03] county spend, which is a $2 million increase over where we anticipate

[1:16:07] you ending this year. And then if you do the BAB recommendation,

[1:16:11] it reduces that by— it reduces that by $600,000. If you

[1:16:16] lean towards the more encompassing plan design changes being recommended

[1:16:20] by us, that takes it a little bit close, a little

[1:16:24] bit further. And then the secondary recommendation after that is is

[1:16:28] how that cost is then shared with employees via

[1:16:32] their premiums, which was that 1% additional cost share that the BAB has

[1:16:35] recommended.

[1:16:40] Thank you. I think for me, I'm— what

[1:16:43] I'm trying to understand, and included in the recommendations of

[1:16:48] those different line items at the beginning of the presentation, first slides or

[1:16:52] so, but what I'm wanting to understand I would

[1:16:56] like to see a world for this next

[1:17:00] year that we're talking about in no increase to deductibles and no increase

[1:17:04] to out-of-pocket max. So I'm

[1:17:08] thinking I might be interested in some of the

[1:17:12] recommendations, but I'm trying to really look at how

[1:17:15] it might not impact employers. And I understand there's a—

[1:17:20] cost of us as the county.

[1:17:32] Courtney or Kyle, do you want to talk a little bit about which— that would—

[1:17:35] yep, if I may comment, that would be this number right here. This is if

[1:17:38] you change nothing, if you leave everything the same, all your plan designs, all your

[1:17:42] deductibles, all your coinsurance, etc.

[1:17:45] That would be— that's what we're referring to as status quo, for lack of a

[1:17:49] better word, and that would be the dollar amount that would then result

[1:17:53] in higher premiums to employees

[1:17:57] versus what we've shown here. Because as a reminder— well, actually,

[1:18:00] no, let me go back. Sorry. What page is the— what page are the premiums

[1:18:04] on, MJ? Team, help me since I'm sharing my screen.

[1:18:12] Sorry, I need to come off here. 29 and 30, Courtney. Okay.

[1:18:17] So here are your 2026

[1:18:21] rates that employees are paying right now. If we don't

[1:18:25] change the plan design, these numbers would all go

[1:18:28] up by even more than what you see over here.

[1:18:32] We don't have a slide for that, but that just directionally So

[1:18:38] if it weren't— the total cost was going up higher, therefore the employee

[1:18:42] cost is— their plan design would stay the same, but their premiums would go up

[1:18:48] And it's— some of it hinges on that cost share

[1:18:52] piece that we talked about, that additional 1%. So if

[1:18:56] they were to keep the current cost share, it would be different than the

[1:18:59] two— the two impacts we're showing here have that higher,

[1:19:02] that 1% higher cost share. Or 10.3%

[1:19:07] currently. Yep. And for reference,

[1:19:11] the BAB did vote on that scenario, leaving the— and

[1:19:15] that was not the prevailing recommendation.

[1:19:22] Okay. So I hear that, and I'm looking at this, and to

[1:19:26] me, an $89 or an $83 or state $60,000 or

[1:19:31] $65,000 is a significant amount of money,

[1:19:35] just taking into account all of the other costs. What I'm looking for is

[1:19:40] if we didn't have that increase, what is that number?

[1:19:45] What's that cost? Like, it was a $4 million number.

[1:19:49] And then I also think maybe— so those are some of my questions,

[1:19:53] Commissioner Soltzman. And then we need to go the different line

[1:19:57] items that are being asked, plan design. Happy to look at that because

[1:20:01] I may help.

[1:20:05] May I clarify? So I believe what you're asking for are two things.

[1:20:09] One, leave the plan design exactly the same, and also

[1:20:12] two, leave premiums exactly the same as they are today

[1:20:17] in 2026. So essentially no increases at all to employees either in

[1:20:21] either bucket. Is that what I'm hearing, or did I misunderstand? I'm actually—

[1:20:25] I'm not looking at the plan design right now. So there is some of

[1:20:29] the plan design that I will be supportive of in the recommendation.

[1:20:33] So it might impact this piece, but what I'm trying to— what I would

[1:20:37] like to see is what would it cost the

[1:20:41] county to not have an increase to the employees' premiums?

[1:20:45] On premiums. Okay.

[1:20:51] I don't know that we have that modeled since that was not a scenario contemplated

[1:20:55] by BAB, unless Kyle or Paige,

[1:20:58] you know otherwise.

[1:21:02] We did not explore that scenario. The current employee contributions

[1:21:06] represent about $4.2 million. So that would be—

[1:21:11] from the status quo scenario, that would be an additional $700,000 shift

[1:21:16] from employees to the county.

[1:21:20] And then the other scenarios would follow similarly. So at $4.2

[1:21:24] million in the middle scenario, the difference there is

[1:21:28] about $1 million. So the county cost would increase by $1 million.

[1:21:34] And that would be pretty close to that in the far right as well.

[1:21:39] To not have a change in the premium. Premiums for this next year.

[1:21:43] Correct. Okay, thank you. Thank you, Kyle.

[1:21:48] Thank you. The question I have that we just haven't covered yet before we get

[1:21:52] into the 5 decision points that we need to make today, um, is just really

[1:21:55] around GLP-1 coverage. I've had a number of employees from

[1:21:58] different departments talk about, you know, previously we were covering GLP-1s and

[1:22:03] it was really helping folks with cholesterol and weight loss and working,

[1:22:06] and many people now are having to pay $500 or more a month to continue

[1:22:10] that coverage since it's no longer covered and just wondered if there was discussion or

[1:22:14] if there are approaches that we could take looking at next

[1:22:18] year in our conversation to try to get some of that

[1:22:21] coverage back for folks. I think the state bulk purchased two particular

[1:22:26] GLP-1 products and I think some other employers are

[1:22:30] taking some innovative approaches. So I wonder if there's any discussion or

[1:22:34] if there's anything we could look at around that space.

[1:22:39] Jamie, may I ask you to chime in on the discussion with, with BAB,

[1:22:43] if any, regarding GLP-1s?

[1:22:46] Yeah, so we have not had any discussion with BAB

[1:22:52] regarding bringing back

[1:22:56] GLP-1 coverage. We did have some general conversations

[1:22:59] around state of the market and what is happening

[1:23:03] in the GLP-1 space. There are some

[1:23:07] non-plan-sponsored options that are available,

[1:23:12] which include direct-to-consumer programs that offer

[1:23:16] the drugs at a lower cost than if they were to just pay a

[1:23:20] cash price at the pharmacy counter.

[1:23:23] And that typically runs $400

[1:23:28] or less. Depending on the dosing and which drug they're picking up, if it's in

[1:23:32] pill form or injectable. But we did

[1:23:35] not explore anything specifically for this year, knowing that we just

[1:23:39] eliminated the coverage in 2020— for 1/1/2026.

[1:23:45] Okay. I do think that's something that's important to talk about at BAB in 2027

[1:23:49] in the discussion, just understanding where people are and getting a pulse on employee

[1:23:54] feedback on that. Um, just because that's something that consistently

[1:23:58] comes up for me when I talk to employees in different departments. I also

[1:24:02] have a question on the same topic, if that is something,

[1:24:06] you know, when you're working on your contracts and sales

[1:24:09] pitches and things with Marathon Health, if that's something that they would consider offering at

[1:24:13] a rate, like at a fee, um, like if that is an expansion

[1:24:17] of services that they'd be interested in providing. I think that may make it more

[1:24:20] likely that people would use the service. Yeah,

[1:24:24] they absolutely have. Go ahead, Courtney, I'll let you speak to it.

[1:24:27] I think you're a little more familiar with the specific program.

[1:24:30] Yes, I was going to say I've made a note to bring up,

[1:24:34] to request that the BAP speak about GLP-1 coverage again next

[1:24:38] year. I won't go to it in the interest of time, but in the appendix

[1:24:41] of this presentation, there is some data on the

[1:24:44] impact of that change and, you know, the amount

[1:24:48] of money that the county is saving as a result of that

[1:24:52] change. And we did review all that information with the BAB as well, and there

[1:24:56] was not a recommendation to bring the coverage back. So, but we will, we will

[1:24:59] add that to the list. You are, your question is

[1:25:03] a fantastic one. I know we don't have anyone from Marathon on the line

[1:25:07] today, but I do know that they are exploring ways in which they can

[1:25:11] add dispensing of certain GLP-1s for certain

[1:25:15] reasons. At their clinics as well.

[1:25:19] That's an active business strategy of Marathon,

[1:25:22] and I agree with you wholeheartedly that if they're able to do that, it would

[1:25:26] certainly increase foot traffic into Marathon clinics if that were the

[1:25:30] only place to obtain your medication for GLP-1s.

[1:25:34] Okay, if they want to talk to a county commissioner, I'm happy to meet with

[1:25:37] them. I'm sure they would love that. We will pass that along. Alright.

[1:25:42] Okay, so I think that brings us to the 5 decision points that we need

[1:25:45] to talk through this afternoon in discussion. You've formatted

[1:25:49] them a little bit different here than they are in our packet.

[1:25:54] Okay, happy to pull the screen down if you'd rather. I think it

[1:25:58] gets us to the same place. I just wonder if Commissioner Lauchman, if your notes

[1:26:02] are in line with what was written in the text of the packet, or if

[1:26:05] you want to go through them in the order they are here. It's slightly different.

[1:26:10] I'm really okay either way. Okay. On this

[1:26:14] slide is totally fine. It makes— so the difference

[1:26:19] I'll just note that I'm noting, and maybe I'm reading it wrong, in the way

[1:26:22] that it was designed in the text of the packet, there are like two differences

[1:26:25] where MJ has a different recommendation than BAB, and I

[1:26:29] think that the way they've been presented here, you've combined both of those into the

[1:26:33] fifth point. Is that right?

[1:26:36] Right? I apologize. I don't have the packet that

[1:26:40] you're looking at in front of us, but I think what you're maybe alluding to

[1:26:43] is the additional plan design changes. Again, it would

[1:26:47] be either 2 or 5. 5 includes those

[1:26:51] additional changes Jamie went through and the out-of-network cross-accumulation

[1:26:54] item. Right. So, like, those are just separated slightly differently.

[1:26:58] Oh, okay. My apologies. I didn't realize it was presented that way. Presented to you

[1:27:02] that way. Okay, so we'll start with Marathon Health. Commissioner Lutchman,

[1:27:06] how do you feel about the BAB recommendation on Marathon Health?

[1:27:10] Do you want to tell me, if you don't mind, which page in the packet

[1:27:14] that you're looking at the decision points? Sure. I just

[1:27:17] flipped to there. Sorry, I'm switching back. So the decision points are actually on

[1:27:25] I'm on one screen, so I'm not,

[1:27:28] but I've got it up in front of me.

[1:27:30] Great.

[1:27:37] Well, maybe I've got the whole packet, so that's—

[1:27:40] just a second. I have

[1:27:45] the 60-page packet up, and it's page 2 is what I have with it on

[1:27:48] there.

[1:27:51] All right, I won't worry about of that piece. Um, let's see here.

[1:27:56] On number 1, introducing the marathon pill.

[1:28:00] Yeah, I'm, I'm in support of it. I, I had

[1:28:04] a lot of questions. I have some concerns that I think are just kind of

[1:28:07] the what-ifs in the world of healthcare and if we get people

[1:28:11] really using this particular addition

[1:28:15] to what's offered and in those 14 start

[1:28:20] to pull back the same way the brick and mortar has in the healthcare space.

[1:28:23] I've got those types of concerns. And just

[1:28:29] seems like there's— it could create another alternative.

[1:28:33] I had a similar question on the JLP as well, Commissioner Sullivan,

[1:28:36] because I thought that was something that was going to be continued.

[1:28:40] I mean, again, what these two events, you know, additional options inside the decision was

[1:28:44] turned back from policy. So I'm glad you brought that back up. And it seems

[1:28:47] like that might be an advocacy piece.

[1:28:52] And there may be some other things that had to remove with the changes that

[1:28:57] I haven't thought about, but I think that makes sense to do

[1:29:00] some advocacy and hopefully with that program. What are

[1:29:04] you thinking on number 1? I think that it is a good thing

[1:29:08] to do with how it's described this year, but similar to you, like I do

[1:29:11] concerns of the what-ifs in the future of like, well, it makes a ton of

[1:29:14] sense as it is now, but is this really just a way to hook people

[1:29:18] in and then it'll be a cost increase or it will, you know, compare differently

[1:29:22] in the future. So I do think we'll have to continue to evaluate it,

[1:29:25] but as it is presented and funded in the, in this decision,

[1:29:29] I think it's a positive choice for employees at no cost that can

[1:29:33] reduce their costs and reduce county costs and give another option. So for

[1:29:37] what it is now, I think it's great and we'll have to just keep a

[1:29:39] close eye on the future for like all the reasons you described.

[1:29:46] Described. Okay, so the second thing we have to talk about is

[1:29:51] the medical plan design changes. So this is where the BAB

[1:29:55] was recommending changing the deductibles and out-of-pockets on both medical

[1:29:58] plans, and they were trying to— it looked like essentially reduce

[1:30:02] the out-of-pocket max compared to the

[1:30:05] MJ Team recommendation on that one. And just MJ Team,

[1:30:09] if you're listening, we're going to talk about the cross-accumulation separately.

[1:30:12] So we're just talking about the— on this particular discussion that

[1:30:17] we're having, we're just talking about the changing the deductibles and out-of-pocket maximums

[1:30:21] on both plans. And I don't know for the discussion if it's helpful to put

[1:30:25] that slide back up or not, or if we can just discuss it. I think

[1:30:29] that we might be trying to find it on the packet.

[1:30:33] This one here, yeah.

[1:30:37] Thank you.

[1:30:40] So this is— thank you. For me,

[1:30:45] what I'm worried about right now is the addition of cost

[1:30:48] period. So when I'm looking at this, it seems like,

[1:30:54] as an example, the current hybrid,

[1:30:58] just on that first line, from $1,500 $1,500 to

[1:31:02] $1,750 or $3,000 to $3,500, that is

[1:31:06] just, that's a significant amount. So I

[1:31:10] would really like us to figure out what we might be able to do to

[1:31:13] reduce, you know, the premium costs,

[1:31:16] whether it's the monthly premium or the visit premium

[1:31:21] or the collective deductible. It's just a lot of money

[1:31:25] for employees. I think that's why we're seeing

[1:31:29] the difference in the BAB recommendation versus the MJ recommendation.

[1:31:32] I think MJ is trying to present something that contains the cost overall and

[1:31:37] the risk overall between the employees and the county. But the BAB, I think,

[1:31:40] tried to land at, you know, we see these costs going up over

[1:31:44] time, we know they're going to increase year on year, and if we can reduce

[1:31:49] that burden on the employees, that has a significant benefit.

[1:31:52] And then I think that when I look at what the BAB's looking at,

[1:31:55] it's just distributing it it, it's talking

[1:31:58] about healthcare is always rotten because it's like, well, obviously no one wants

[1:32:02] to get sick, but if you get sick, you hope that collectively society is going

[1:32:05] to like pitch in and we're gonna help cover the costs together. So I,

[1:32:09] I just, I see the BAB recommendation. Um, and I

[1:32:13] think I would lean toward what the BAB is recommend— recommending

[1:32:16] on this over MJ because I think it's trying to get at addressing

[1:32:20] what you're trying to address, but recognizing that the costs are accelerating so

[1:32:24] much and in this medical space?

[1:32:30] I think when I look at this, I'm reading this as

[1:32:34] something in the chat here. Is that something you want to share,

[1:32:38] Courtney? Well, I just— I— Sure,

[1:32:42] go ahead, Courtney.

[1:32:46] So I didn't know if that data point would be helpful or if it was

[1:32:49] appropriate for us to chime in that the virtual setting is difficult. I apologize,

[1:32:52] but just, wanted to make sure that the data point was shared that the

[1:32:57] out-of-pocket maximum is generally not applicable to most members.

[1:33:00] It is very— it is reached by only a subset of the population.

[1:33:06] Sure. That was all. Thank you. I think

[1:33:11] what I'd like to just explore a little bit is I appreciate

[1:33:16] Fab's work and, of course, MJ's work as well. And if

[1:33:22] there's a way for us to decrease that cost

[1:33:26] even to the amount that the BAF is

[1:33:30] recommended, I think you're right that they're acknowledging that there

[1:33:33] is most likely going to be a change. But I think the BAF ability

[1:33:37] as well to look at what would that cost be and what could we consider.

[1:33:41] And I know that probably makes it complicated from, you know,

[1:33:45] OFM sitting there trying to run numbers. But I,

[1:33:48] if there's interest, Commissioner Salzman, I would like us to see if we could add

[1:33:52] something in there to reduce the third item.

[1:33:57] Sorry, will you just repeat reduce which item? The burden

[1:34:01] of the,

[1:34:04] just the, the actual cost to employees. And so if

[1:34:09] that's premium, if that's the deductible, if that's wherever that is,

[1:34:12] I think I would like to see us add something into both

[1:34:16] of those. Um, so I don't think we have all of

[1:34:21] the information we would need to be able to do that today, because I think

[1:34:25] the piece that's missing is like that essentially creates what I was hearing from Kyle

[1:34:28] is an additional million dollars, um, in funding

[1:34:33] gap from the county side per year. So like, as far as our structural debt

[1:34:37] goes, like that actually makes us have to find another million dollars And so

[1:34:40] I think we would need OFM to do some additional work on

[1:34:44] that. So I guess the question I have for— I would normally send

[1:34:48] it toward Emily Cooper, so I'm sort of wondering who's with us in the room

[1:34:51] that can help us, but about the necessity of having

[1:34:54] this decision made today. Is there someone from

[1:34:57] HR on this call?

[1:35:02] Hi, Ashley. It's Stephanie Hyatt. Yes, I can work with the

[1:35:06] MJ team and finance, OFM,

[1:35:10] and they can crunch the numbers to see what

[1:35:14] that would look like. Do we have time for that, Stephanie? That's what— that's the

[1:35:18] question that I was wondering is like, is this like, do we need to have

[1:35:21] this locked in? Is it time sensitive for today, or do we have time

[1:35:25] to get that info back? I do think

[1:35:29] we have a little bit of time.

[1:35:33] If, you know, if that's something that you want to see before you're

[1:35:37] comfortable making a decision,

[1:35:43] I don't think that the BAB is planning to be

[1:35:46] meeting again. So as long as you're okay with just

[1:35:51] getting those numbers and making the decision with,

[1:35:54] you know, what OFM provides

[1:35:58] and the MJ team with kind of revising and

[1:36:03] adding to, Yeah, so I think what we need

[1:36:07] is sort of a fourth, basically a fourth option presented here that would show the

[1:36:12] in-out-of-pocket maxes and the deductibles

[1:36:17] staying the same essentially, right, Commissioner Lochaman, and shifting that

[1:36:21] percentage. So instead of the, I forget what the actual presents were,

[1:36:24] but it was something like 84% to

[1:36:29] the county, shifting that county share and then showing what that does. Does for

[1:36:33] the recurring expenditure from OFM side. Does that make sense, Kyle, what we're

[1:36:37] asking to look at? Yeah, I just wanted— this is Kyle Sullivan— I just wanted

[1:36:40] to confirm. So we're talking about the same, so basically it would

[1:36:44] take our status quo scenario that we showed, but we would be combining

[1:36:49] that with the current 2026 employee cost share, and then

[1:36:53] what does that mean to the county from absorbing

[1:36:57] those additional costs. Yeah, the current

[1:37:02] employee payment, not cost share, because the share would shift to the county,

[1:37:06] right? Yeah, so employees would pay the same in payroll

[1:37:10] deductions and have as close to possible the current plan design.

[1:37:15] And that's the reason I mentioned that is there's a bullet at the bottom of

[1:37:18] this page that the IRS requires a $50 and $100 increase

[1:37:23] to the deductible to remain compliant. So there will be some change,

[1:37:27] but that's as close to no changes as possible.

[1:37:32] So yes, that is the design we're hoping to see more detail on.

[1:37:36] Okay. Yeah, that— thank you for that, everyone. I just want to add

[1:37:40] a response for— I'm sorry,

[1:37:44] I think it was Stephanie, maybe. Yes. Thank you.

[1:37:47] I would feel comfortable with out because I feel like

[1:37:52] this would be more favorable. So just, just in regards

[1:37:55] to the— just say, I think that would be okay.

[1:38:00] Want to check in on Commissioner Sullivan. If it was going the other direction,

[1:38:03] maybe I would want to have conversation, additional meetings.

[1:38:09] I actually— sorry, could you just say that again? I, I wasn't understanding.

[1:38:13] Oh yeah, um, I, I thought I heard

[1:38:17] a question from Stephanie or a comment about if the board would feel

[1:38:21] comfortable, um, seeing changes without

[1:38:25] having the— a board member present.

[1:38:29] And for me, what I'm asking would be more favorable for

[1:38:33] staff, and so it doesn't concern me about not having an additional meeting. Is that

[1:38:37] clear? Yes. Yeah, thank you for clarifying. Yeah,

[1:38:41] I'm The part

[1:38:44] of it that would be very nice to have Bob weigh in on, of course,

[1:38:47] is like what the effect of the structural deficit

[1:38:51] is. I think that was in some of the notes of the conversation, but I

[1:38:54] think they have contributed quite a lot of feedback. So seeing

[1:38:58] that other scenario, I think builds on the feedback we've gotten, and then we can

[1:39:01] compare the 4 scenarios that we have and have that discussion.

[1:39:05] That's great. Thanks. All right. The next topic

[1:39:09] is the medical premium contribution changes. Is. And I

[1:39:13] don't know if you all want to change slides back again, but I think

[1:39:20] the medical premium contribution changes, it looked like MJ and Bab

[1:39:24] were in alignment on. But do we need

[1:39:28] to put a pause in this discussion if we're waiting for that other information?

[1:39:32] Yes. Okay. So we'll put a pause on that.

[1:39:35] And then the next discussion is termination of the MindCo benefits.

[1:39:39] Benefit, and it looked like Bab and MJ were in agreement that we

[1:39:43] would recommend terminating

[1:39:47] the MindCo benefit and save the $110,000 a year.

[1:39:51] Any discussion on that one? I'm supportive of those recommendations and

[1:39:55] having some of that additional information just to

[1:39:59] understand the context because I had heard something different as well last year. So it's

[1:40:02] helpful again for evaluation, just review.

[1:40:10] Great. And then the last topic is the cross-accumulation on the consumer

[1:40:14] choice plan. Any discussion on that? If I can just

[1:40:17] ask Commissioner Solzman, I'm guessing you were fine with my recommendation. I just

[1:40:21] didn't hear— Oh, sorry. Yes, I support also. Sorry about that.

[1:40:25] Support the plan. The last one is this cross-accumulation of the

[1:40:30] consumer choice plan. And so Bab was recommending that

[1:40:33] we go ahead and leave it like it is designed now where the consumer choice

[1:40:37] plan is a little bit different out of network than the other plan. And MJ

[1:40:41] was recommending making them both the same.

[1:40:44] That— this one concerned me when I see the amount

[1:40:48] of people who will be impacted. Me too.

[1:40:53] And so I just feel like there's so much changes going on with so many

[1:40:56] different processes, certainly depending on where we're going in regards to a

[1:41:00] change in premiums for people. I would rather

[1:41:05] not make that change at this point. All right.

[1:41:09] So I think what we would be doing today is it sounds like

[1:41:13] we agree to direct staff to adopt the BABB recommendation

[1:41:18] on Marathon Health, adopt the BABB recommendation

[1:41:22] on the MindCo benefit, and adopt the BABB recommendation on

[1:41:26] the cost accumulation, which is to not make a change in that space. So those

[1:41:29] would be the 3 BAB changes that we're giving direction to move forward

[1:41:33] with today. And then we're going to come back at a future meeting and continue

[1:41:36] to discuss the medical plan design changes and the medical

[1:41:41] premium contribution changes.

[1:41:45] Is that right? Well, help me if the

[1:41:50] first 3 part— first 3 pieces, Yes, the one that you

[1:41:53] just said about coming back for plan design. I guess I was

[1:41:58] interpreting all of these changes as plan design, so I just want to make

[1:42:02] sure that the group knows what we're asking. What I read in the

[1:42:06] packet is plan design. It says BABB recommends changing the

[1:42:09] deductibles and out-of-pocket maximums on both medical plans and some small

[1:42:13] changes to prescription copay tiers on the hybrid plan. These changes

[1:42:17] will help lower the 16% increase increase in premiums

[1:42:20] to 14.6, and then the MJ team recommended further bringing

[1:42:24] it down to 13.4%. That was the thing that was described as medical

[1:42:28] plan design changes, and that's what I think we have to come

[1:42:31] back and talk more about with the additional scenario that you've described

[1:42:36] that we'll look at. And then in concert with that, they called medical

[1:42:39] premium contribution changes in the packet. The BABB recommended shifting 1% of the

[1:42:43] premium contribution split from the county employees, making it

[1:42:47] an 85.7% county paid and 14.3% employee paid.

[1:42:52] And in that one, Bab and MJ had agreed, but I think we can't decide

[1:42:56] on that without the additional information that you had put together too. So that's what

[1:43:00] I'm talking about when I talk about the coming back to talk about medical plan

[1:43:03] design changes and medical premium contribution changes. I think

[1:43:08] that's a great clarifier. Okay, and so we can go ahead

[1:43:12] and move forward with direction to staff on the Bab recommendation

[1:43:16] on those other 3 items, and we'll come back at a future meeting on those

[1:43:19] remaining 2. I'll turn back over to

[1:43:23] Stephanie to see if there was anything else she needs us to answer today.

[1:43:27] I don't have anything else. I'll work with everyone involved, and we'll

[1:43:31] get that future meeting scheduled.

[1:43:35] Excellent. Thank you all very much for being here today,

[1:43:38] and just another thanks from the board, Kelly and BAB members,

[1:43:41] for all the time and energy you've put into it and helping us understand how

[1:43:46] this will affect each of your departments. It is a tremendous amount of time and

[1:43:49] work you put in talking to everybody, going to all the meetings, understanding all the

[1:43:53] actuarial data, and it is really helpful. So thank

[1:43:57] you very much. And with that, we'll be adjourned for the day. Thank you all.

[1:44:00] Thank you. Thank you. Bye-bye. Thank you,

Board of County Commissioners - Regular Meeting

Agenda

Transcript