1 01:00:00,774 --> 01:00:03,740 taking advantage of out-of-network benefits today, 2 01:00:03,756 --> 01:00:08,688 270 on the hybrid plan. That is not 3 01:00:09,188 --> 01:00:12,968 a cross-accumulation issue, but the 357 individuals 4 01:00:13,468 --> 01:00:18,947 on the consumer choice ICE plan would be impacted if 5 01:00:19,447 --> 01:00:21,777 we were to move forward with removing that cross-accumulation, 6 01:00:23,847 --> 01:00:26,417 which is the recommendation of MJ. 7 01:00:34,134 --> 01:00:37,857 Not seeing any questions. We can keep going. Okay. Thank you, 8 01:00:37,905 --> 01:00:42,013 Jamie. And I think just to put a bow on this one, the The 9 01:00:42,045 --> 01:00:45,657 plan would still have out-of-network coverage. Members can still 10 01:00:46,157 --> 01:00:49,639 go out of network just like they do today. The only change is 11 01:00:49,671 --> 01:00:53,139 that they have to satisfy separate deductibles and separate out-of-pocket maximums, 12 01:00:53,589 --> 01:00:55,708 whereas today they get— they can kind of blend the two. 13 01:00:56,800 --> 01:01:00,525 Honestly, it's about equity between the plans more than anything else. 14 01:01:00,910 --> 01:01:03,495 There's a lot of risk and a lot of exposure that Jamie touched on, 15 01:01:03,704 --> 01:01:07,461 but it's really about, in our isolated MJ opinion, 16 01:01:07,959 --> 01:01:11,958 treating the same— treating members on both plans the same. But that's 17 01:01:12,458 --> 01:01:15,847 my takeaway. All right, 18 01:01:15,928 --> 01:01:19,171 one more final BAB recommendation before we move on to 19 01:01:19,671 --> 01:01:23,287 premiums, and this one's over to Andrea. Yes, thank you. 20 01:01:23,367 --> 01:01:27,221 This is Andrea Crone again from the MJ Companies. So, as I noted 21 01:01:27,237 --> 01:01:30,669 earlier, the MindCo utilization— so, again, 22 01:01:31,507 --> 01:01:35,346 to Commissioner Stoltzman's question earlier, really utilization, 23 01:01:35,443 --> 01:01:37,689 who's actually using the program and engaging in it. 24 01:01:38,458 --> 01:01:42,342 Using the app is, is far below what is needed for those programs to 25 01:01:42,842 --> 01:01:46,403 really have a meaningful impact for your employees. I will add really quickly, 26 01:01:46,435 --> 01:01:50,095 and I should have said this before, the BAB members did also seek 27 01:01:50,595 --> 01:01:54,044 feedback from each of their departments on MindCo, if they 28 01:01:54,544 --> 01:01:58,442 had used it, what their feedback was. And, and to your point exactly, 29 01:01:58,458 --> 01:02:01,492 Commissioner Stoltzman, there was feedback around, I've used it, 30 01:02:01,909 --> 01:02:04,847 but I was dissatisfied with the app, or the headset didn't work, or it was 31 01:02:04,879 --> 01:02:08,636 uncomfortable, or I didn't want another app. So there was some, some relevant 32 01:02:09,136 --> 01:02:13,197 feedback there. Um, the county does have alternative 33 01:02:13,213 --> 01:02:17,212 stress relief and tobacco cessation support that's already available through 34 01:02:17,244 --> 01:02:21,323 programs that you have in place. So, for example, through your employee assistance 35 01:02:21,823 --> 01:02:25,418 program with CareLink, um, your medical and pharmacy plans can help treat 36 01:02:25,980 --> 01:02:29,256 mental health and stress disorders as well as prescribe medications as 37 01:02:29,368 --> 01:02:32,612 needed. And then you also do have a wellness program that's already in 38 01:02:32,724 --> 01:02:36,243 place that that offer support for these specific types of services. 39 01:02:36,821 --> 01:02:40,902 So with that information in mind, both the BAB and MJ recommend terminating 40 01:02:40,934 --> 01:02:45,818 this program for 2027. This will result in about $110,000 41 01:02:46,318 --> 01:02:50,091 per year in savings for the county. And really where that comes in is MindCo 42 01:02:50,591 --> 01:02:54,317 charges a per employee per month fee for every eligible 43 01:02:54,349 --> 01:02:58,028 employee, regardless of whether they are using the program. And so 44 01:02:58,528 --> 01:03:01,816 again, with such low utilization maybe around 8 or so people 45 01:03:01,833 --> 01:03:05,958 per year using each of these programs, but you're still paying for 46 01:03:06,458 --> 01:03:10,166 the full population to have access. And for your consideration, 47 01:03:10,182 --> 01:03:13,660 we have included some additional information about this recommendation in 48 01:03:13,709 --> 01:03:14,591 the appendix. 49 01:03:19,273 --> 01:03:24,117 Thank you. All right, 50 01:03:24,134 --> 01:03:29,043 Kyle. All right, Kyle Sullivan here to talk a little bit about 51 01:03:29,543 --> 01:03:32,887 what the employee premiums might look like. So as Andrea mentioned, we did have— the 52 01:03:33,387 --> 01:03:37,803 BAB did survey their members 53 01:03:38,222 --> 01:03:41,949 and the members they represented, and one of the things they came back with 54 01:03:42,449 --> 01:03:46,284 is they wanted to ensure that there's a balanced approach to managing costs. So not 55 01:03:46,784 --> 01:03:50,527 only looking at changing the benefit design, but also considering changes to 56 01:03:51,106 --> 01:03:54,929 the employee premium premiums that come out of their paychecks. 57 01:03:55,829 --> 01:03:59,059 During the BAB session, they recommended shifting an additional 58 01:03:59,172 --> 01:04:02,854 1% of employee premium cost share to employees 59 01:04:03,048 --> 01:04:06,354 in a way— or in an effort to help manage 60 01:04:06,434 --> 01:04:10,111 and reduce the cost increase to the county. 61 01:04:12,479 --> 01:04:16,184 Both of the scenarios that we'll look at here will show a status quo scenario, 62 01:04:16,571 --> 01:04:20,184 and then we'll discuss the two proposed scenarios. So just to set the 63 01:04:20,684 --> 01:04:25,325 baseline, the status quo scenario based on our current cost share has the 64 01:04:25,958 --> 01:04:29,088 $36.9 million total broken 65 01:04:29,185 --> 01:04:33,110 into the county portion and the employee portion. So the employee portion 66 01:04:33,610 --> 01:04:37,572 is currently 13.3% of the total annual 67 01:04:37,782 --> 01:04:41,935 plan spend, and the county portion is 86.7%. 68 01:04:44,141 --> 01:04:48,495 If we look at what that cost shift looks like, like combined 69 01:04:48,528 --> 01:04:52,298 with the plan design savings in each scenario, 70 01:04:53,004 --> 01:04:56,117 the 14.3% with the BABB recommended 71 01:04:56,133 --> 01:05:00,610 scenario has the total costs that have been reduced by $600,000. 72 01:05:00,674 --> 01:05:05,456 So the $36.3 million split into 14.3% 73 01:05:06,483 --> 01:05:09,195 of the total covered by employees, 74 01:05:09,692 --> 01:05:12,934 that would be an increase of about $300,000 75 01:05:13,239 --> 01:05:16,724 from an employee cost basis. 76 01:05:17,530 --> 01:05:21,820 With the additional savings and the additional $400,000 77 01:05:22,320 --> 01:05:26,060 savings in the MJ recommended scenario, that cost increase is 78 01:05:26,157 --> 01:05:28,797 reduced by about $60,000 to employees, 79 01:05:29,458 --> 01:05:32,565 and the employee cost share again is the 14.3%. 80 01:05:33,805 --> 01:05:37,479 I want to note that these cost shares of either 13% 81 01:05:37,512 --> 01:05:41,283 or 14% are very competitive among municipalities and 82 01:05:41,379 --> 01:05:44,717 employers in general. And we'll note on the next slide what 83 01:05:44,733 --> 01:05:48,323 that actual dollar amount to people's paycheck, the change 84 01:05:48,823 --> 01:05:52,108 looks like. But I just wanted to comment that it's been important for 85 01:05:52,608 --> 01:05:56,030 us to ensure that we're aligning with benchmark and ensuring 86 01:05:56,079 --> 01:06:00,195 that the full benefit package, both from a plan design perspective and 87 01:06:00,695 --> 01:06:03,139 a payroll deduction perspective, is robust. 88 01:06:04,858 --> 01:06:07,765 Can we stay on this slide for just a minute? Commissioner Litschman, do you have 89 01:06:08,265 --> 01:06:10,967 any questions? I do. I just am getting one other piece of information before before 90 01:06:10,983 --> 01:06:14,531 I can ask mine. Thank you. 91 01:06:14,981 --> 01:06:18,340 I'm waiting for the slide that shows the breakdown of 92 01:06:18,356 --> 01:06:21,489 what that costs with the different employees. So, okay. 93 01:06:22,630 --> 01:06:25,898 Thank you for asking. Are you breaking this down further on the next slide, 94 01:06:26,092 --> 01:06:29,686 Kyle? Yeah. Yes. The next slide will show the monthly rate. So it will 95 01:06:29,816 --> 01:06:33,407 absolutely address or help address that. Let's see 96 01:06:33,907 --> 01:06:36,814 that, and I might have you go back to that last slide also. Sure. 97 01:06:37,012 --> 01:06:41,013 Perfect. So we want to start on the left here with our current plan design 98 01:06:41,513 --> 01:06:45,255 offering and our current payroll deduction. So on the top, just orienting, 99 01:06:45,352 --> 01:06:49,883 we have the Consumer Choice Plan. These are all monthly employee 100 01:06:49,947 --> 01:06:54,093 deductions based on the plan election and the coverage 101 01:06:54,189 --> 01:06:58,383 tier election. If we're looking at the middle column, 102 01:06:58,624 --> 01:07:02,465 this represents the change on a monthly basis based on each scenario. 103 01:07:02,626 --> 01:07:06,183 As I mentioned, a balanced approach with less plan design changes. 104 01:07:06,247 --> 01:07:10,237 There is an additional increase, or a slightly higher increase, 105 01:07:10,253 --> 01:07:14,179 to employee rates. On the Consumer Choice Plan, the monthly 106 01:07:14,679 --> 01:07:18,585 change is between $16 for employee only and $69 for 107 01:07:19,085 --> 01:07:22,912 family coverage. In total, we're still looking at a 108 01:07:23,412 --> 01:07:27,222 little bit over $350 per month for family coverage, which is extremely 109 01:07:27,302 --> 01:07:31,337 competitive, especially in the current healthcare market 110 01:07:32,127 --> 01:07:35,384 space and considering 111 01:07:35,416 --> 01:07:38,690 how much your plan design 112 01:07:39,190 --> 01:07:42,915 covers is very competitive. From a hybrid plan perspective, 113 01:07:42,964 --> 01:07:46,997 that increase is higher, so it's $22 114 01:07:47,497 --> 01:07:51,806 for an employee per month in addition to our current amount and an additional 115 01:07:51,936 --> 01:07:55,020 $89 for family coverage. Still, 116 01:07:55,052 --> 01:07:58,525 we're our total family per employee 117 01:07:59,025 --> 01:08:02,792 per month rate would be less than $500 for your 118 01:08:02,905 --> 01:08:04,004 buy-up plan offering. 119 01:08:06,355 --> 01:08:08,555 Do you have a question at this point or do we want to talk? 120 01:08:08,863 --> 01:08:12,308 Yeah. No, I think I do. So if you could go back to 121 01:08:12,324 --> 01:08:15,009 the last slide, I think it's a little cleaner of a question on that slide. 122 01:08:15,730 --> 01:08:20,613 So on the— I 123 01:08:20,662 --> 01:08:24,281 see that you've tried And the BAB recommendation and your recommendation, 124 01:08:24,377 --> 01:08:27,671 you're trying to show a similar cost share between the county and 125 01:08:28,171 --> 01:08:31,888 the employee of the county. And so going back to the plan design that 126 01:08:31,953 --> 01:08:35,775 drives that, you're essentially trying to 127 01:08:35,824 --> 01:08:40,784 drive down that cost to the employees and county by increasing the out-of-pocket 128 01:08:41,284 --> 01:08:45,122 max and reducing the risk. Is that right, Kyle? For the total, yeah. 129 01:08:45,186 --> 01:08:48,432 So the total amount reduces due to that. And I 130 01:08:48,464 --> 01:08:51,610 honestly probably should have highlighted the county's portion here because that's one of the really 131 01:08:52,229 --> 01:08:56,187 key considerations. If we look at the county status quo, we're looking 132 01:08:56,251 --> 01:08:59,664 at $32.0 million. In the middle column 133 01:08:59,857 --> 01:09:04,600 with the recommended change in cost sharing and plan design, we're looking at $31.1 134 01:09:05,100 --> 01:09:09,376 million. So a $900,000 difference. And then in the MJ recommendation, 135 01:09:10,049 --> 01:09:14,311 we're looking at the $30.8 million. So that's 136 01:09:14,811 --> 01:09:18,686 a piece I should have mentioned earlier. No, I see that. I'm really focused 137 01:09:19,186 --> 01:09:22,468 on the employee row, actually. And so it looks like you've tried to keep that 138 01:09:22,968 --> 01:09:26,927 14.3 to 85. fixed while using 139 01:09:26,959 --> 01:09:30,745 the plan design to reduce the risk basically on 140 01:09:30,873 --> 01:09:34,852 your side. So the risk is essentially getting shifted to employees that may 141 01:09:34,916 --> 01:09:38,686 experience more sickness, like right in their out-of-pocket max, 142 01:09:38,734 --> 01:09:42,664 that's where it's made up for. Is that right? Correct. That's what's driving the 143 01:09:43,164 --> 01:09:46,818 change in the total. All right. So like as far as like who 144 01:09:46,834 --> 01:09:50,508 benefits and who burdens between the raspberry color and the purple color, 145 01:09:50,556 --> 01:09:54,438 like the employees that are experiencing more chronic illness or maybe hitting 146 01:09:54,470 --> 01:09:57,888 their out-of-pocket max are who are being burdened with the purple design? 147 01:09:58,642 --> 01:10:02,284 Correct. There would be— and then healthier employees are benefiting 148 01:10:02,396 --> 01:10:06,055 in the raspberry, or I guess healthier employees are benefiting in the purple. 149 01:10:07,290 --> 01:10:09,970 Yes, from a plan design perspective. 150 01:10:10,419 --> 01:10:14,366 One of the considerations discussed during the BAB was that there's this interplay 151 01:10:14,866 --> 01:10:18,297 between if the county is paying more in benefits, that that also might 152 01:10:18,797 --> 01:10:22,971 reduce the amount of compensation that could be passed on. And so that 153 01:10:23,471 --> 01:10:27,264 was one of the considerations in the purple is if 154 01:10:27,328 --> 01:10:31,759 we're able to mitigate cost there, that it might help ensure 155 01:10:32,259 --> 01:10:35,510 that employee increases are not burdened by additional increases 156 01:10:35,590 --> 01:10:38,665 from the benefit plan. 157 01:10:38,762 --> 01:10:42,308 I mean, but you're just positing that because we've not talked about that. So I 158 01:10:42,808 --> 01:10:45,740 don't have any other questions. Thank you. Thank you. 159 01:10:47,431 --> 01:10:51,248 Kyle, it's Courtney again. If I could just chime in, I really appreciate Commissioner 160 01:10:51,748 --> 01:10:55,327 Stoltzman's comments. One analogy I like to use is if you focus 161 01:10:55,424 --> 01:10:58,621 first on the total, that number gets smaller as we move 162 01:10:58,734 --> 01:11:02,880 into raspberry and into purple, so that the entire pie gets 163 01:11:03,380 --> 01:11:06,639 smaller when you change plan design because the dollars, you know, 164 01:11:06,930 --> 01:11:10,674 the dollars, the cost of the dollars go down. Obviously, the employees have 165 01:11:11,174 --> 01:11:14,312 to pay more at the time they use care. So that's decision point number 1, 166 01:11:14,408 --> 01:11:18,078 which was driven by Marathon and the plan design changes, obviously, we've been talking 167 01:11:18,126 --> 01:11:21,796 about. Step 2 is to then determine how does that pie get divided 168 01:11:22,296 --> 01:11:24,921 into 2 pieces, the piece the county pays for in premiums versus the piece the 169 01:11:25,421 --> 01:11:28,206 employee pays for in premiums. And that's driven by this cost share. 170 01:11:28,686 --> 01:11:31,587 So it's, you know, you'll notice this 1% shift. 171 01:11:31,795 --> 01:11:35,385 It's 13.3% today. The proposal is for the employees 172 01:11:35,417 --> 01:11:38,237 to pick up an additional point of the total. 173 01:11:39,013 --> 01:11:42,159 The total is smaller in these two scenarios, 174 01:11:42,256 --> 01:11:45,207 and you're absolutely right that it's a bit of a balance between, 175 01:11:46,250 --> 01:11:49,461 you know, if we've got this pie to split in half, 176 01:11:50,986 --> 01:11:53,289 you know, raspberry gets you a lower number through, 177 01:11:54,807 --> 01:11:58,478 gets you lower on plan design. Purple gets you even lower 178 01:11:58,607 --> 01:12:01,988 on plan design, but you're absolutely right that people who would feel that would be 179 01:12:02,488 --> 01:12:05,638 the people who use care the most, i.e., being the 180 01:12:06,138 --> 01:12:09,977 sicker or the folks that just use more care. And that was exactly the 181 01:12:10,477 --> 01:12:13,481 conversation during the BAB and all that is outlined on the readout in the back. 182 01:12:13,530 --> 01:12:15,642 So you articulated that perfectly. 183 01:12:16,829 --> 01:12:19,088 Thank you. Any other questions on the plan design? 184 01:12:22,510 --> 01:12:24,666 At this time, thank you. Thank you. 185 01:12:26,400 --> 01:12:28,313 So let's see, next topic. 186 01:12:30,826 --> 01:12:33,414 Any questions on the rates and the change to the employees either? 187 01:12:36,250 --> 01:12:39,555 Just in regards to the rates, for me, I think my questions are going 188 01:12:40,055 --> 01:12:43,931 to come later when we're talking about the actual figures and numbers. 189 01:12:43,979 --> 01:12:47,834 So I'm holding on to thinking about this 190 01:12:48,334 --> 01:12:49,442 one. Okay. 191 01:12:53,460 --> 01:12:57,524 Dental premiums. Dental premiums are very exciting 192 01:12:57,557 --> 01:13:00,928 this year. There are no changes to dental premiums as we're in 193 01:13:01,428 --> 01:13:05,056 a rate guarantee. So I'm pleased to present the current 194 01:13:05,556 --> 01:13:09,049 and 2027 dental premiums and employee deductions. 195 01:13:11,160 --> 01:13:15,396 Thank you. Vision premiums. Very similar to dental, one of my favorite subjects. 196 01:13:15,800 --> 01:13:19,454 We're in a great spot for having these rates locked in for another year. 197 01:13:19,535 --> 01:13:23,446 So no changes to vision premiums. 198 01:13:23,559 --> 01:13:27,629 Thank you. All right, 199 01:13:27,694 --> 01:13:31,406 this is Andrea Crone again. Just a quick renewal summary here for 200 01:13:31,906 --> 01:13:34,973 you. Really, this is highlighting when your programs 201 01:13:35,053 --> 01:13:38,378 are up for the next round of RFPs. Just wanted 202 01:13:38,878 --> 01:13:41,764 to highlight that we did complete RFPs this year for life, 203 01:13:41,909 --> 01:13:45,337 disability, FMLA, and leave administration 204 01:13:45,369 --> 01:13:47,429 earlier this year, so those have been completed. 205 01:13:48,178 --> 01:13:51,694 And the RFP panels of course voted to move those 206 01:13:51,791 --> 01:13:55,179 programs from Lincoln Financial over to Unum for life and 207 01:13:55,679 --> 01:13:59,385 disability, and then to bring the leave administration 208 01:14:00,140 --> 01:14:03,512 in-house with a software called PulpStream. We do have 209 01:14:04,012 --> 01:14:08,104 the stop-loss RFP coming up. That is something that we typically market 210 01:14:08,604 --> 01:14:12,006 every year just to ensure you're getting the most competitive rates. So that is 211 01:14:12,182 --> 01:14:15,827 upcoming. And then, of course, the virtual mental health and tobacco 212 01:14:16,327 --> 01:14:20,195 cessation through MindCo that we do recommend terminating that on 213 01:14:20,307 --> 01:14:21,945 December 31st, '26. 214 01:14:23,438 --> 01:14:26,955 And then after that, we do have some additional RFPs coming up next 215 01:14:27,455 --> 01:14:31,017 year, really high-level, just flexible spending accounts, COBRA administration, 216 01:14:31,145 --> 01:14:34,437 and identity theft. And then we're, we're good for a little while after that 217 01:14:34,937 --> 01:14:36,974 on the need for RFPs for these programs. 218 01:14:40,858 --> 01:14:44,121 Thank you. Before we go to the discussion 219 01:14:44,621 --> 01:14:47,997 on those topics, just are there any other topics commissioners have that weren't covered 220 01:14:48,497 --> 01:14:49,839 in the presentation or ready for discussion? 221 01:14:53,488 --> 01:14:56,885 For me, Commissioner Salzman, I'm really— I 222 01:14:56,998 --> 01:15:00,535 want to have a discussion with you around the 223 01:15:01,053 --> 01:15:04,882 recommendations and what I'm wanting to look 224 01:15:05,010 --> 01:15:08,726 at more specifically what happens if we don't make a change 225 01:15:09,273 --> 01:15:11,509 on the benefits. What does that mean to our members? 226 01:15:13,010 --> 01:15:15,712 So if this is the right time to talk about that, that's great. If it's 227 01:15:16,212 --> 01:15:16,966 later, that's fine too. 228 01:15:19,228 --> 01:15:22,913 That's great. We will— we can do that right now. I think that I 229 01:15:23,123 --> 01:15:26,081 wonder if MJ or Budget has any, 230 01:15:27,427 --> 01:15:31,109 you know, sometimes we see a slide that shows like 231 01:15:31,190 --> 01:15:34,415 the overall cost of like status quo, overall cost of the BAB recommendation, overall cost 232 01:15:36,139 --> 01:15:39,366 of the MJ recommendation. I wonder if we have something like that you could take 233 01:15:39,866 --> 01:15:43,972 us through. Yep. Let me go back to that. Thanks, Courtney. That was 23, 234 01:15:44,037 --> 01:15:45,330 I think. Oh, nope. 235 01:15:48,062 --> 01:15:49,986 Oh, boy. Trying to go backwards. This one. 236 01:15:51,635 --> 01:15:55,185 This is specific to medical because that's the only piece that's changing in cost. 237 01:15:55,266 --> 01:15:58,705 Everything else is staying the same. So, we're— if you do 238 01:15:59,205 --> 01:16:03,209 nothing, it's a 36.9% $1 million total 239 01:16:03,709 --> 01:16:07,370 county spend, which is a $2 million increase over where we anticipate 240 01:16:07,870 --> 01:16:11,629 you ending this year. And then if you do the BAB recommendation, 241 01:16:11,645 --> 01:16:15,565 it reduces that by— it reduces that by $600,000. If you 242 01:16:16,065 --> 01:16:19,599 lean towards the more encompassing plan design changes being recommended 243 01:16:20,099 --> 01:16:23,616 by us, that takes it a little bit close, a little 244 01:16:24,116 --> 01:16:28,259 bit further. And then the secondary recommendation after that is is 245 01:16:28,356 --> 01:16:32,066 how that cost is then shared with employees via 246 01:16:32,566 --> 01:16:35,905 their premiums, which was that 1% additional cost share that the BAB has 247 01:16:35,921 --> 01:16:36,405 recommended. 248 01:16:40,679 --> 01:16:43,781 Thank you. I think for me, I'm— what 249 01:16:43,813 --> 01:16:47,527 I'm trying to understand, and included in the recommendations of 250 01:16:48,027 --> 01:16:51,822 those different line items at the beginning of the presentation, first slides or 251 01:16:52,322 --> 01:16:55,577 so, but what I'm wanting to understand I would 252 01:16:56,077 --> 01:16:59,591 like to see a world for this next 253 01:17:00,779 --> 01:17:04,825 year that we're talking about in no increase to deductibles and no increase 254 01:17:04,873 --> 01:17:08,599 to out-of-pocket max. So I'm 255 01:17:08,647 --> 01:17:11,714 thinking I might be interested in some of the 256 01:17:12,214 --> 01:17:15,680 recommendations, but I'm trying to really look at how 257 01:17:15,792 --> 01:17:19,501 it might not impact employers. And I understand there's a— 258 01:17:20,069 --> 01:17:21,638 cost of us as the county. 259 01:17:32,102 --> 01:17:35,476 Courtney or Kyle, do you want to talk a little bit about which— that would— 260 01:17:35,637 --> 01:17:38,369 yep, if I may comment, that would be this number right here. This is if 261 01:17:38,869 --> 01:17:42,327 you change nothing, if you leave everything the same, all your plan designs, all your 262 01:17:42,827 --> 01:17:45,264 deductibles, all your coinsurance, etc. 263 01:17:45,994 --> 01:17:49,028 That would be— that's what we're referring to as status quo, for lack of a 264 01:17:49,528 --> 01:17:53,042 better word, and that would be the dollar amount that would then result 265 01:17:53,123 --> 01:17:57,281 in higher premiums to employees 266 01:17:57,314 --> 01:18:00,766 versus what we've shown here. Because as a reminder— well, actually, 267 01:18:00,782 --> 01:18:04,507 no, let me go back. Sorry. What page is the— what page are the premiums 268 01:18:04,603 --> 01:18:06,803 on, MJ? Team, help me since I'm sharing my screen. 269 01:18:12,503 --> 01:18:16,180 Sorry, I need to come off here. 29 and 30, Courtney. Okay. 270 01:18:17,063 --> 01:18:20,451 So here are your 2026 271 01:18:21,222 --> 01:18:25,059 rates that employees are paying right now. If we don't 272 01:18:25,075 --> 01:18:28,704 change the plan design, these numbers would all go 273 01:18:28,849 --> 01:18:31,209 up by even more than what you see over here. 274 01:18:32,301 --> 01:18:38,163 We don't have a slide for that, but that just directionally So 275 01:18:38,663 --> 01:18:41,896 if it weren't— the total cost was going up higher, therefore the employee 276 01:18:42,396 --> 01:18:44,902 cost is— their plan design would stay the same, but their premiums would go up 277 01:18:48,418 --> 01:18:51,612 And it's— some of it hinges on that cost share 278 01:18:52,128 --> 01:18:56,032 piece that we talked about, that additional 1%. So if 279 01:18:56,080 --> 01:18:59,271 they were to keep the current cost share, it would be different than the 280 01:18:59,384 --> 01:19:02,555 two— the two impacts we're showing here have that higher, 281 01:19:02,764 --> 01:19:07,105 that 1% higher cost share. Or 10.3% 282 01:19:07,443 --> 01:19:10,840 currently. Yep. And for reference, 283 01:19:11,146 --> 01:19:15,024 the BAB did vote on that scenario, leaving the— and 284 01:19:15,524 --> 01:19:17,544 that was not the prevailing recommendation. 285 01:19:22,732 --> 01:19:26,445 Okay. So I hear that, and I'm looking at this, and to 286 01:19:26,945 --> 01:19:31,160 me, an $89 or an $83 or state $60,000 or 287 01:19:31,660 --> 01:19:34,670 $65,000 is a significant amount of money, 288 01:19:35,560 --> 01:19:40,080 just taking into account all of the other costs. What I'm looking for is 289 01:19:40,580 --> 01:19:44,760 if we didn't have that increase, what is that number? 290 01:19:45,260 --> 01:19:48,520 What's that cost? Like, it was a $4 million number. 291 01:19:49,820 --> 01:19:53,440 And then I also think maybe— so those are some of my questions, 292 01:19:53,580 --> 01:19:57,013 Commissioner Soltzman. And then we need to go the different line 293 01:19:57,513 --> 01:20:01,023 items that are being asked, plan design. Happy to look at that because 294 01:20:01,055 --> 01:20:01,458 I may help. 295 01:20:05,116 --> 01:20:08,158 May I clarify? So I believe what you're asking for are two things. 296 01:20:09,226 --> 01:20:12,834 One, leave the plan design exactly the same, and also 297 01:20:12,882 --> 01:20:16,577 two, leave premiums exactly the same as they are today 298 01:20:17,077 --> 01:20:21,320 in 2026. So essentially no increases at all to employees either in 299 01:20:21,432 --> 01:20:25,524 either bucket. Is that what I'm hearing, or did I misunderstand? I'm actually— 300 01:20:25,718 --> 01:20:29,315 I'm not looking at the plan design right now. So there is some of 301 01:20:29,815 --> 01:20:33,058 the plan design that I will be supportive of in the recommendation. 302 01:20:33,510 --> 01:20:36,852 So it might impact this piece, but what I'm trying to— what I would 303 01:20:37,352 --> 01:20:40,827 like to see is what would it cost the 304 01:20:41,327 --> 01:20:45,398 county to not have an increase to the employees' premiums? 305 01:20:45,608 --> 01:20:46,678 On premiums. Okay. 306 01:20:51,477 --> 01:20:55,088 I don't know that we have that modeled since that was not a scenario contemplated 307 01:20:55,120 --> 01:20:57,970 by BAB, unless Kyle or Paige, 308 01:20:58,747 --> 01:21:00,235 you know otherwise. 309 01:21:02,563 --> 01:21:06,733 We did not explore that scenario. The current employee contributions 310 01:21:06,830 --> 01:21:10,247 represent about $4.2 million. So that would be— 311 01:21:11,600 --> 01:21:16,330 from the status quo scenario, that would be an additional $700,000 shift 312 01:21:16,346 --> 01:21:18,758 from employees to the county. 313 01:21:20,473 --> 01:21:24,127 And then the other scenarios would follow similarly. So at $4.2 314 01:21:24,627 --> 01:21:27,912 million in the middle scenario, the difference there is 315 01:21:28,412 --> 01:21:31,859 about $1 million. So the county cost would increase by $1 million. 316 01:21:34,407 --> 01:21:37,751 And that would be pretty close to that in the far right as well. 317 01:21:39,866 --> 01:21:42,564 To not have a change in the premium. Premiums for this next year. 318 01:21:43,605 --> 01:21:46,469 Correct. Okay, thank you. Thank you, Kyle. 319 01:21:48,607 --> 01:21:51,518 Thank you. The question I have that we just haven't covered yet before we get 320 01:21:52,018 --> 01:21:55,060 into the 5 decision points that we need to make today, um, is just really 321 01:21:55,157 --> 01:21:58,406 around GLP-1 coverage. I've had a number of employees from 322 01:21:58,906 --> 01:22:02,600 different departments talk about, you know, previously we were covering GLP-1s and 323 01:22:03,100 --> 01:22:06,682 it was really helping folks with cholesterol and weight loss and working, 324 01:22:06,779 --> 01:22:10,472 and many people now are having to pay $500 or more a month to continue 325 01:22:10,972 --> 01:22:13,970 that coverage since it's no longer covered and just wondered if there was discussion or 326 01:22:14,483 --> 01:22:18,206 if there are approaches that we could take looking at next 327 01:22:18,706 --> 01:22:21,752 year in our conversation to try to get some of that 328 01:22:21,864 --> 01:22:25,811 coverage back for folks. I think the state bulk purchased two particular 329 01:22:26,311 --> 01:22:30,497 GLP-1 products and I think some other employers are 330 01:22:30,850 --> 01:22:34,412 taking some innovative approaches. So I wonder if there's any discussion or 331 01:22:34,637 --> 01:22:36,836 if there's anything we could look at around that space. 332 01:22:39,681 --> 01:22:43,282 Jamie, may I ask you to chime in on the discussion with, with BAB, 333 01:22:43,298 --> 01:22:45,635 if any, regarding GLP-1s? 334 01:22:46,446 --> 01:22:50,711 Yeah, so we have not had any discussion with BAB 335 01:22:52,104 --> 01:22:55,262 regarding bringing back 336 01:22:56,035 --> 01:22:59,806 GLP-1 coverage. We did have some general conversations 337 01:22:59,822 --> 01:23:03,496 around state of the market and what is happening 338 01:23:03,609 --> 01:23:07,266 in the GLP-1 space. There are some 339 01:23:07,476 --> 01:23:12,099 non-plan-sponsored options that are available, 340 01:23:12,228 --> 01:23:16,126 which include direct-to-consumer programs that offer 341 01:23:16,159 --> 01:23:19,880 the drugs at a lower cost than if they were to just pay a 342 01:23:20,380 --> 01:23:22,565 cash price at the pharmacy counter. 343 01:23:23,666 --> 01:23:28,441 And that typically runs $400 344 01:23:28,941 --> 01:23:32,352 or less. Depending on the dosing and which drug they're picking up, if it's in 345 01:23:32,467 --> 01:23:35,500 pill form or injectable. But we did 346 01:23:35,516 --> 01:23:39,087 not explore anything specifically for this year, knowing that we just 347 01:23:39,587 --> 01:23:43,911 eliminated the coverage in 2020— for 1/1/2026. 348 01:23:45,935 --> 01:23:49,760 Okay. I do think that's something that's important to talk about at BAB in 2027 349 01:23:49,955 --> 01:23:53,954 in the discussion, just understanding where people are and getting a pulse on employee 350 01:23:54,454 --> 01:23:58,229 feedback on that. Um, just because that's something that consistently 351 01:23:58,729 --> 01:24:02,703 comes up for me when I talk to employees in different departments. I also 352 01:24:02,719 --> 01:24:05,654 have a question on the same topic, if that is something, 353 01:24:06,007 --> 01:24:09,454 you know, when you're working on your contracts and sales 354 01:24:09,954 --> 01:24:13,127 pitches and things with Marathon Health, if that's something that they would consider offering at 355 01:24:13,627 --> 01:24:16,992 a rate, like at a fee, um, like if that is an expansion 356 01:24:17,072 --> 01:24:20,295 of services that they'd be interested in providing. I think that may make it more 357 01:24:20,343 --> 01:24:23,984 likely that people would use the service. Yeah, 358 01:24:24,065 --> 01:24:27,360 they absolutely have. Go ahead, Courtney, I'll let you speak to it. 359 01:24:27,441 --> 01:24:29,945 I think you're a little more familiar with the specific program. 360 01:24:30,686 --> 01:24:34,348 Yes, I was going to say I've made a note to bring up, 361 01:24:34,413 --> 01:24:37,704 to request that the BAP speak about GLP-1 coverage again next 362 01:24:38,204 --> 01:24:41,129 year. I won't go to it in the interest of time, but in the appendix 363 01:24:41,194 --> 01:24:44,847 of this presentation, there is some data on the 364 01:24:44,928 --> 01:24:48,321 impact of that change and, you know, the amount 365 01:24:48,821 --> 01:24:52,056 of money that the county is saving as a result of that 366 01:24:52,556 --> 01:24:55,661 change. And we did review all that information with the BAB as well, and there 367 01:24:56,161 --> 01:24:59,795 was not a recommendation to bring the coverage back. So, but we will, we will 368 01:24:59,892 --> 01:25:03,449 add that to the list. You are, your question is 369 01:25:03,949 --> 01:25:07,278 a fantastic one. I know we don't have anyone from Marathon on the line 370 01:25:07,778 --> 01:25:11,252 today, but I do know that they are exploring ways in which they can 371 01:25:11,428 --> 01:25:15,178 add dispensing of certain GLP-1s for certain 372 01:25:15,290 --> 01:25:18,531 reasons. At their clinics as well. 373 01:25:19,382 --> 01:25:22,481 That's an active business strategy of Marathon, 374 01:25:22,513 --> 01:25:26,062 and I agree with you wholeheartedly that if they're able to do that, it would 375 01:25:26,562 --> 01:25:30,140 certainly increase foot traffic into Marathon clinics if that were the 376 01:25:30,221 --> 01:25:33,737 only place to obtain your medication for GLP-1s. 377 01:25:34,877 --> 01:25:37,302 Okay, if they want to talk to a county commissioner, I'm happy to meet with 378 01:25:37,350 --> 01:25:40,995 them. I'm sure they would love that. We will pass that along. Alright. 379 01:25:42,283 --> 01:25:45,334 Okay, so I think that brings us to the 5 decision points that we need 380 01:25:45,834 --> 01:25:49,870 to talk through this afternoon in discussion. You've formatted 381 01:25:49,903 --> 01:25:52,587 them a little bit different here than they are in our packet. 382 01:25:54,378 --> 01:25:58,387 Okay, happy to pull the screen down if you'd rather. I think it 383 01:25:58,887 --> 01:26:02,026 gets us to the same place. I just wonder if Commissioner Lauchman, if your notes 384 01:26:02,526 --> 01:26:05,495 are in line with what was written in the text of the packet, or if 385 01:26:05,995 --> 01:26:10,680 you want to go through them in the order they are here. It's slightly different. 386 01:26:10,793 --> 01:26:14,232 I'm really okay either way. Okay. On this 387 01:26:14,732 --> 01:26:18,915 slide is totally fine. It makes— so the difference 388 01:26:19,415 --> 01:26:21,974 I'll just note that I'm noting, and maybe I'm reading it wrong, in the way 389 01:26:22,474 --> 01:26:25,483 that it was designed in the text of the packet, there are like two differences 390 01:26:25,580 --> 01:26:29,075 where MJ has a different recommendation than BAB, and I 391 01:26:29,575 --> 01:26:32,804 think that the way they've been presented here, you've combined both of those into the 392 01:26:33,304 --> 01:26:34,085 fifth point. Is that right? 393 01:26:36,775 --> 01:26:40,335 Right? I apologize. I don't have the packet that 394 01:26:40,383 --> 01:26:43,266 you're looking at in front of us, but I think what you're maybe alluding to 395 01:26:43,282 --> 01:26:46,743 is the additional plan design changes. Again, it would 396 01:26:47,243 --> 01:26:50,910 be either 2 or 5. 5 includes those 397 01:26:51,006 --> 01:26:54,779 additional changes Jamie went through and the out-of-network cross-accumulation 398 01:26:54,876 --> 01:26:58,364 item. Right. So, like, those are just separated slightly differently. 399 01:26:58,429 --> 01:27:02,318 Oh, okay. My apologies. I didn't realize it was presented that way. Presented to you 400 01:27:02,818 --> 01:27:06,179 that way. Okay, so we'll start with Marathon Health. Commissioner Lutchman, 401 01:27:06,195 --> 01:27:09,394 how do you feel about the BAB recommendation on Marathon Health? 402 01:27:10,510 --> 01:27:13,595 Do you want to tell me, if you don't mind, which page in the packet 403 01:27:14,095 --> 01:27:17,629 that you're looking at the decision points? Sure. I just 404 01:27:17,773 --> 01:27:21,304 flipped to there. Sorry, I'm switching back. So the decision points are actually on 405 01:27:25,300 --> 01:27:28,382 I'm on one screen, so I'm not, 406 01:27:28,447 --> 01:27:29,449 but I've got it up in front of me. 407 01:27:30,990 --> 01:27:34,327 Great. 408 01:27:37,133 --> 01:27:40,200 Well, maybe I've got the whole packet, so that's— 409 01:27:40,700 --> 01:27:44,566 just a second. I have 410 01:27:45,066 --> 01:27:48,420 the 60-page packet up, and it's page 2 is what I have with it on 411 01:27:48,476 --> 01:27:48,682 there. 412 01:27:51,756 --> 01:27:56,293 All right, I won't worry about of that piece. Um, let's see here. 413 01:27:56,422 --> 01:27:59,034 On number 1, introducing the marathon pill. 414 01:28:00,428 --> 01:28:04,242 Yeah, I'm, I'm in support of it. I, I had 415 01:28:04,354 --> 01:28:07,543 a lot of questions. I have some concerns that I think are just kind of 416 01:28:07,559 --> 01:28:11,149 the what-ifs in the world of healthcare and if we get people 417 01:28:11,485 --> 01:28:15,075 really using this particular addition 418 01:28:15,267 --> 01:28:20,400 to what's offered and in those 14 start 419 01:28:20,900 --> 01:28:23,804 to pull back the same way the brick and mortar has in the healthcare space. 420 01:28:23,916 --> 01:28:28,765 I've got those types of concerns. And just 421 01:28:29,231 --> 01:28:32,892 seems like there's— it could create another alternative. 422 01:28:33,422 --> 01:28:36,922 I had a similar question on the JLP as well, Commissioner Sullivan, 423 01:28:36,938 --> 01:28:40,503 because I thought that was something that was going to be continued. 424 01:28:40,567 --> 01:28:44,056 I mean, again, what these two events, you know, additional options inside the decision was 425 01:28:44,154 --> 01:28:47,870 turned back from policy. So I'm glad you brought that back up. And it seems 426 01:28:47,886 --> 01:28:49,493 like that might be an advocacy piece. 427 01:28:52,279 --> 01:28:56,637 And there may be some other things that had to remove with the changes that 428 01:28:57,137 --> 01:29:00,362 I haven't thought about, but I think that makes sense to do 429 01:29:00,862 --> 01:29:04,445 some advocacy and hopefully with that program. What are 430 01:29:04,462 --> 01:29:07,996 you thinking on number 1? I think that it is a good thing 431 01:29:08,028 --> 01:29:11,450 to do with how it's described this year, but similar to you, like I do 432 01:29:11,492 --> 01:29:14,655 concerns of the what-ifs in the future of like, well, it makes a ton of 433 01:29:14,687 --> 01:29:18,139 sense as it is now, but is this really just a way to hook people 434 01:29:18,639 --> 01:29:21,993 in and then it'll be a cost increase or it will, you know, compare differently 435 01:29:22,493 --> 01:29:24,771 in the future. So I do think we'll have to continue to evaluate it, 436 01:29:25,221 --> 01:29:29,412 but as it is presented and funded in the, in this decision, 437 01:29:29,556 --> 01:29:32,687 I think it's a positive choice for employees at no cost that can 438 01:29:33,187 --> 01:29:36,862 reduce their costs and reduce county costs and give another option. So for 439 01:29:37,362 --> 01:29:39,624 what it is now, I think it's great and we'll have to just keep a 440 01:29:39,736 --> 01:29:42,305 close eye on the future for like all the reasons you described. 441 01:29:46,951 --> 01:29:50,856 Described. Okay, so the second thing we have to talk about is 442 01:29:51,034 --> 01:29:54,518 the medical plan design changes. So this is where the BAB 443 01:29:55,018 --> 01:29:58,398 was recommending changing the deductibles and out-of-pockets on both medical 444 01:29:58,898 --> 01:30:02,306 plans, and they were trying to— it looked like essentially reduce 445 01:30:02,418 --> 01:30:05,555 the out-of-pocket max compared to the 446 01:30:05,796 --> 01:30:09,078 MJ Team recommendation on that one. And just MJ Team, 447 01:30:09,094 --> 01:30:12,285 if you're listening, we're going to talk about the cross-accumulation separately. 448 01:30:12,896 --> 01:30:16,958 So we're just talking about the— on this particular discussion that 449 01:30:17,458 --> 01:30:21,213 we're having, we're just talking about the changing the deductibles and out-of-pocket maximums 450 01:30:21,713 --> 01:30:24,761 on both plans. And I don't know for the discussion if it's helpful to put 451 01:30:25,261 --> 01:30:28,760 that slide back up or not, or if we can just discuss it. I think 452 01:30:29,260 --> 01:30:31,907 that we might be trying to find it on the packet. 453 01:30:33,336 --> 01:30:34,090 This one here, yeah. 454 01:30:37,205 --> 01:30:39,357 Thank you. 455 01:30:40,818 --> 01:30:43,644 So this is— thank you. For me, 456 01:30:45,073 --> 01:30:48,493 what I'm worried about right now is the addition of cost 457 01:30:48,525 --> 01:30:53,663 period. So when I'm looking at this, it seems like, 458 01:30:54,868 --> 01:30:57,485 as an example, the current hybrid, 459 01:30:58,641 --> 01:31:02,176 just on that first line, from $1,500 $1,500 to 460 01:31:02,676 --> 01:31:06,016 $1,750 or $3,000 to $3,500, that is 461 01:31:06,548 --> 01:31:10,195 just, that's a significant amount. So I 462 01:31:10,243 --> 01:31:13,068 would really like us to figure out what we might be able to do to 463 01:31:13,568 --> 01:31:16,701 reduce, you know, the premium costs, 464 01:31:16,944 --> 01:31:20,659 whether it's the monthly premium or the visit premium 465 01:31:21,128 --> 01:31:24,866 or the collective deductible. It's just a lot of money 466 01:31:25,190 --> 01:31:29,192 for employees. I think that's why we're seeing 467 01:31:29,224 --> 01:31:32,645 the difference in the BAB recommendation versus the MJ recommendation. 468 01:31:32,694 --> 01:31:37,535 I think MJ is trying to present something that contains the cost overall and 469 01:31:37,567 --> 01:31:40,817 the risk overall between the employees and the county. But the BAB, I think, 470 01:31:40,947 --> 01:31:44,342 tried to land at, you know, we see these costs going up over 471 01:31:44,842 --> 01:31:48,706 time, we know they're going to increase year on year, and if we can reduce 472 01:31:49,206 --> 01:31:51,878 that burden on the employees, that has a significant benefit. 473 01:31:52,635 --> 01:31:54,996 And then I think that when I look at what the BAB's looking at, 474 01:31:55,013 --> 01:31:58,858 it's just distributing it it, it's talking 475 01:31:58,891 --> 01:32:02,036 about healthcare is always rotten because it's like, well, obviously no one wants 476 01:32:02,536 --> 01:32:05,841 to get sick, but if you get sick, you hope that collectively society is going 477 01:32:05,857 --> 01:32:09,147 to like pitch in and we're gonna help cover the costs together. So I, 478 01:32:09,227 --> 01:32:13,047 I just, I see the BAB recommendation. Um, and I 479 01:32:13,096 --> 01:32:16,514 think I would lean toward what the BAB is recommend— recommending 480 01:32:16,611 --> 01:32:20,286 on this over MJ because I think it's trying to get at addressing 481 01:32:20,318 --> 01:32:24,171 what you're trying to address, but recognizing that the costs are accelerating so 482 01:32:24,671 --> 01:32:26,162 much and in this medical space? 483 01:32:30,781 --> 01:32:34,470 I think when I look at this, I'm reading this as 484 01:32:34,486 --> 01:32:37,945 something in the chat here. Is that something you want to share, 485 01:32:38,010 --> 01:32:42,526 Courtney? Well, I just— I— Sure, 486 01:32:42,802 --> 01:32:43,403 go ahead, Courtney. 487 01:32:46,747 --> 01:32:49,358 So I didn't know if that data point would be helpful or if it was 488 01:32:49,858 --> 01:32:52,855 appropriate for us to chime in that the virtual setting is difficult. I apologize, 489 01:32:52,952 --> 01:32:56,538 but just, wanted to make sure that the data point was shared that the 490 01:32:57,038 --> 01:33:00,139 out-of-pocket maximum is generally not applicable to most members. 491 01:33:00,640 --> 01:33:04,007 It is very— it is reached by only a subset of the population. 492 01:33:06,424 --> 01:33:10,829 Sure. That was all. Thank you. I think 493 01:33:11,329 --> 01:33:16,186 what I'd like to just explore a little bit is I appreciate 494 01:33:16,332 --> 01:33:21,715 Fab's work and, of course, MJ's work as well. And if 495 01:33:22,215 --> 01:33:25,979 there's a way for us to decrease that cost 496 01:33:26,027 --> 01:33:29,986 even to the amount that the BAF is 497 01:33:30,050 --> 01:33:33,657 recommended, I think you're right that they're acknowledging that there 498 01:33:33,673 --> 01:33:37,424 is most likely going to be a change. But I think the BAF ability 499 01:33:37,924 --> 01:33:41,239 as well to look at what would that cost be and what could we consider. 500 01:33:41,896 --> 01:33:45,086 And I know that probably makes it complicated from, you know, 501 01:33:45,102 --> 01:33:47,847 OFM sitting there trying to run numbers. But I, 502 01:33:48,880 --> 01:33:52,477 if there's interest, Commissioner Salzman, I would like us to see if we could add 503 01:33:52,525 --> 01:33:55,348 something in there to reduce the third item. 504 01:33:57,708 --> 01:34:01,237 Sorry, will you just repeat reduce which item? The burden 505 01:34:01,350 --> 01:34:03,066 of the, 506 01:34:04,927 --> 01:34:08,636 just the, the actual cost to employees. And so if 507 01:34:09,136 --> 01:34:12,508 that's premium, if that's the deductible, if that's wherever that is, 508 01:34:12,540 --> 01:34:16,395 I think I would like to see us add something into both 509 01:34:16,895 --> 01:34:20,693 of those. Um, so I don't think we have all of 510 01:34:21,193 --> 01:34:24,646 the information we would need to be able to do that today, because I think 511 01:34:25,146 --> 01:34:28,806 the piece that's missing is like that essentially creates what I was hearing from Kyle 512 01:34:28,870 --> 01:34:32,629 is an additional million dollars, um, in funding 513 01:34:33,129 --> 01:34:36,646 gap from the county side per year. So like, as far as our structural debt 514 01:34:37,146 --> 01:34:40,203 goes, like that actually makes us have to find another million dollars And so 515 01:34:40,235 --> 01:34:43,600 I think we would need OFM to do some additional work on 516 01:34:44,100 --> 01:34:48,188 that. So I guess the question I have for— I would normally send 517 01:34:48,688 --> 01:34:50,998 it toward Emily Cooper, so I'm sort of wondering who's with us in the room 518 01:34:51,030 --> 01:34:54,315 that can help us, but about the necessity of having 519 01:34:54,412 --> 01:34:57,874 this decision made today. Is there someone from 520 01:34:57,890 --> 01:34:58,958 HR on this call? 521 01:35:02,924 --> 01:35:06,805 Hi, Ashley. It's Stephanie Hyatt. Yes, I can work with the 522 01:35:06,886 --> 01:35:09,555 MJ team and finance, OFM, 523 01:35:10,376 --> 01:35:14,253 and they can crunch the numbers to see what 524 01:35:14,753 --> 01:35:17,646 that would look like. Do we have time for that, Stephanie? That's what— that's the 525 01:35:18,146 --> 01:35:21,240 question that I was wondering is like, is this like, do we need to have 526 01:35:21,740 --> 01:35:25,373 this locked in? Is it time sensitive for today, or do we have time 527 01:35:25,421 --> 01:35:29,306 to get that info back? I do think 528 01:35:29,806 --> 01:35:30,614 we have a little bit of time. 529 01:35:33,212 --> 01:35:37,386 If, you know, if that's something that you want to see before you're 530 01:35:37,466 --> 01:35:38,707 comfortable making a decision, 531 01:35:43,193 --> 01:35:46,544 I don't think that the BAB is planning to be 532 01:35:46,771 --> 01:35:50,980 meeting again. So as long as you're okay with just 533 01:35:51,480 --> 01:35:53,342 getting those numbers and making the decision with, 534 01:35:54,134 --> 01:35:58,388 you know, what OFM provides 535 01:35:58,485 --> 01:36:02,534 and the MJ team with kind of revising and 536 01:36:03,034 --> 01:36:06,706 adding to, Yeah, so I think what we need 537 01:36:07,206 --> 01:36:11,197 is sort of a fourth, basically a fourth option presented here that would show the 538 01:36:12,612 --> 01:36:16,625 in-out-of-pocket maxes and the deductibles 539 01:36:17,078 --> 01:36:20,686 staying the same essentially, right, Commissioner Lochaman, and shifting that 540 01:36:21,186 --> 01:36:24,580 percentage. So instead of the, I forget what the actual presents were, 541 01:36:24,628 --> 01:36:28,580 but it was something like 84% to 542 01:36:29,080 --> 01:36:33,110 the county, shifting that county share and then showing what that does. Does for 543 01:36:33,610 --> 01:36:37,004 the recurring expenditure from OFM side. Does that make sense, Kyle, what we're 544 01:36:37,084 --> 01:36:40,001 asking to look at? Yeah, I just wanted— this is Kyle Sullivan— I just wanted 545 01:36:40,501 --> 01:36:44,055 to confirm. So we're talking about the same, so basically it would 546 01:36:44,555 --> 01:36:49,087 take our status quo scenario that we showed, but we would be combining 547 01:36:49,119 --> 01:36:53,093 that with the current 2026 employee cost share, and then 548 01:36:53,205 --> 01:36:57,340 what does that mean to the county from absorbing 549 01:36:57,774 --> 01:37:01,789 those additional costs. Yeah, the current 550 01:37:02,289 --> 01:37:05,402 employee payment, not cost share, because the share would shift to the county, 551 01:37:06,402 --> 01:37:09,968 right? Yeah, so employees would pay the same in payroll 552 01:37:10,468 --> 01:37:14,115 deductions and have as close to possible the current plan design. 553 01:37:15,980 --> 01:37:18,875 And that's the reason I mentioned that is there's a bullet at the bottom of 554 01:37:18,907 --> 01:37:22,805 this page that the IRS requires a $50 and $100 increase 555 01:37:23,305 --> 01:37:26,834 to the deductible to remain compliant. So there will be some change, 556 01:37:27,672 --> 01:37:31,138 but that's as close to no changes as possible. 557 01:37:32,140 --> 01:37:34,758 So yes, that is the design we're hoping to see more detail on. 558 01:37:36,549 --> 01:37:40,183 Okay. Yeah, that— thank you for that, everyone. I just want to add 559 01:37:40,376 --> 01:37:44,138 a response for— I'm sorry, 560 01:37:44,170 --> 01:37:46,866 I think it was Stephanie, maybe. Yes. Thank you. 561 01:37:47,972 --> 01:37:51,575 I would feel comfortable with out because I feel like 562 01:37:52,075 --> 01:37:55,295 this would be more favorable. So just, just in regards 563 01:37:55,795 --> 01:37:59,390 to the— just say, I think that would be okay. 564 01:38:00,267 --> 01:38:03,827 Want to check in on Commissioner Sullivan. If it was going the other direction, 565 01:38:03,940 --> 01:38:07,553 maybe I would want to have conversation, additional meetings. 566 01:38:09,499 --> 01:38:12,859 I actually— sorry, could you just say that again? I, I wasn't understanding. 567 01:38:13,679 --> 01:38:17,257 Oh yeah, um, I, I thought I heard 568 01:38:17,757 --> 01:38:21,137 a question from Stephanie or a comment about if the board would feel 569 01:38:21,266 --> 01:38:25,195 comfortable, um, seeing changes without 570 01:38:25,259 --> 01:38:28,418 having the— a board member present. 571 01:38:29,108 --> 01:38:32,828 And for me, what I'm asking would be more favorable for 572 01:38:33,328 --> 01:38:37,366 staff, and so it doesn't concern me about not having an additional meeting. Is that 573 01:38:37,866 --> 01:38:41,119 clear? Yes. Yeah, thank you for clarifying. Yeah, 574 01:38:41,151 --> 01:38:44,481 I'm The part 575 01:38:44,981 --> 01:38:47,501 of it that would be very nice to have Bob weigh in on, of course, 576 01:38:47,679 --> 01:38:51,022 is like what the effect of the structural deficit 577 01:38:51,522 --> 01:38:54,314 is. I think that was in some of the notes of the conversation, but I 578 01:38:54,379 --> 01:38:58,154 think they have contributed quite a lot of feedback. So seeing 579 01:38:58,187 --> 01:39:01,140 that other scenario, I think builds on the feedback we've gotten, and then we can 580 01:39:01,640 --> 01:39:04,218 compare the 4 scenarios that we have and have that discussion. 581 01:39:05,597 --> 01:39:09,125 That's great. Thanks. All right. The next topic 582 01:39:09,625 --> 01:39:13,079 is the medical premium contribution changes. Is. And I 583 01:39:13,225 --> 01:39:17,280 don't know if you all want to change slides back again, but I think 584 01:39:20,302 --> 01:39:24,150 the medical premium contribution changes, it looked like MJ and Bab 585 01:39:24,199 --> 01:39:27,796 were in alignment on. But do we need 586 01:39:28,296 --> 01:39:30,634 to put a pause in this discussion if we're waiting for that other information? 587 01:39:32,388 --> 01:39:35,646 Yes. Okay. So we'll put a pause on that. 588 01:39:35,775 --> 01:39:39,565 And then the next discussion is termination of the MindCo benefits. 589 01:39:39,730 --> 01:39:43,615 Benefit, and it looked like Bab and MJ were in agreement that we 590 01:39:43,712 --> 01:39:47,662 would recommend terminating 591 01:39:47,695 --> 01:39:51,128 the MindCo benefit and save the $110,000 a year. 592 01:39:51,646 --> 01:39:55,291 Any discussion on that one? I'm supportive of those recommendations and 593 01:39:55,307 --> 01:39:58,786 having some of that additional information just to 594 01:39:59,286 --> 01:40:02,228 understand the context because I had heard something different as well last year. So it's 595 01:40:02,584 --> 01:40:05,299 helpful again for evaluation, just review. 596 01:40:10,033 --> 01:40:13,733 Great. And then the last topic is the cross-accumulation on the consumer 597 01:40:14,233 --> 01:40:17,754 choice plan. Any discussion on that? If I can just 598 01:40:17,818 --> 01:40:21,260 ask Commissioner Solzman, I'm guessing you were fine with my recommendation. I just 599 01:40:21,760 --> 01:40:24,444 didn't hear— Oh, sorry. Yes, I support also. Sorry about that. 600 01:40:25,830 --> 01:40:29,587 Support the plan. The last one is this cross-accumulation of the 601 01:40:30,087 --> 01:40:33,383 consumer choice plan. And so Bab was recommending that 602 01:40:33,511 --> 01:40:37,047 we go ahead and leave it like it is designed now where the consumer choice 603 01:40:37,547 --> 01:40:40,647 plan is a little bit different out of network than the other plan. And MJ 604 01:40:41,147 --> 01:40:43,363 was recommending making them both the same. 605 01:40:44,842 --> 01:40:48,346 That— this one concerned me when I see the amount 606 01:40:48,362 --> 01:40:52,167 of people who will be impacted. Me too. 607 01:40:53,221 --> 01:40:56,350 And so I just feel like there's so much changes going on with so many 608 01:40:56,850 --> 01:41:00,249 different processes, certainly depending on where we're going in regards to a 609 01:41:00,313 --> 01:41:05,451 change in premiums for people. I would rather 610 01:41:05,515 --> 01:41:09,047 not make that change at this point. All right. 611 01:41:09,368 --> 01:41:12,756 So I think what we would be doing today is it sounds like 612 01:41:13,256 --> 01:41:17,283 we agree to direct staff to adopt the BABB recommendation 613 01:41:18,037 --> 01:41:22,035 on Marathon Health, adopt the BABB recommendation 614 01:41:22,131 --> 01:41:26,049 on the MindCo benefit, and adopt the BABB recommendation on 615 01:41:26,081 --> 01:41:29,612 the cost accumulation, which is to not make a change in that space. So those 616 01:41:29,645 --> 01:41:33,488 would be the 3 BAB changes that we're giving direction to move forward 617 01:41:33,988 --> 01:41:36,799 with today. And then we're going to come back at a future meeting and continue 618 01:41:36,847 --> 01:41:40,544 to discuss the medical plan design changes and the medical 619 01:41:41,044 --> 01:41:42,059 premium contribution changes. 620 01:41:45,707 --> 01:41:49,775 Is that right? Well, help me if the 621 01:41:50,275 --> 01:41:53,498 first 3 part— first 3 pieces, Yes, the one that you 622 01:41:53,998 --> 01:41:57,810 just said about coming back for plan design. I guess I was 623 01:41:58,003 --> 01:42:01,834 interpreting all of these changes as plan design, so I just want to make 624 01:42:02,334 --> 01:42:06,018 sure that the group knows what we're asking. What I read in the 625 01:42:06,082 --> 01:42:09,368 packet is plan design. It says BABB recommends changing the 626 01:42:09,868 --> 01:42:13,311 deductibles and out-of-pocket maximums on both medical plans and some small 627 01:42:13,811 --> 01:42:17,286 changes to prescription copay tiers on the hybrid plan. These changes 628 01:42:17,318 --> 01:42:20,573 will help lower the 16% increase increase in premiums 629 01:42:20,589 --> 01:42:24,260 to 14.6, and then the MJ team recommended further bringing 630 01:42:24,308 --> 01:42:28,284 it down to 13.4%. That was the thing that was described as medical 631 01:42:28,300 --> 01:42:31,811 plan design changes, and that's what I think we have to come 632 01:42:31,827 --> 01:42:35,754 back and talk more about with the additional scenario that you've described 633 01:42:36,254 --> 01:42:39,441 that we'll look at. And then in concert with that, they called medical 634 01:42:39,941 --> 01:42:43,770 premium contribution changes in the packet. The BABB recommended shifting 1% of the 635 01:42:43,850 --> 01:42:47,135 premium contribution split from the county employees, making it 636 01:42:47,635 --> 01:42:51,236 an 85.7% county paid and 14.3% employee paid. 637 01:42:52,085 --> 01:42:55,850 And in that one, Bab and MJ had agreed, but I think we can't decide 638 01:42:56,350 --> 01:42:59,887 on that without the additional information that you had put together too. So that's what 639 01:43:00,387 --> 01:43:03,668 I'm talking about when I talk about the coming back to talk about medical plan 640 01:43:03,716 --> 01:43:07,545 design changes and medical premium contribution changes. I think 641 01:43:08,045 --> 01:43:11,727 that's a great clarifier. Okay, and so we can go ahead 642 01:43:12,111 --> 01:43:15,880 and move forward with direction to staff on the Bab recommendation 643 01:43:16,380 --> 01:43:19,098 on those other 3 items, and we'll come back at a future meeting on those 644 01:43:19,131 --> 01:43:22,543 remaining 2. I'll turn back over to 645 01:43:23,043 --> 01:43:25,387 Stephanie to see if there was anything else she needs us to answer today. 646 01:43:27,412 --> 01:43:31,214 I don't have anything else. I'll work with everyone involved, and we'll 647 01:43:31,714 --> 01:43:33,608 get that future meeting scheduled. 648 01:43:35,332 --> 01:43:38,376 Excellent. Thank you all very much for being here today, 649 01:43:38,456 --> 01:43:41,339 and just another thanks from the board, Kelly and BAB members, 650 01:43:41,616 --> 01:43:45,711 for all the time and energy you've put into it and helping us understand how 651 01:43:46,211 --> 01:43:49,323 this will affect each of your departments. It is a tremendous amount of time and 652 01:43:49,404 --> 01:43:52,775 work you put in talking to everybody, going to all the meetings, understanding all the 653 01:43:53,275 --> 01:43:56,790 actuarial data, and it is really helpful. So thank 654 01:43:57,290 --> 01:44:00,097 you very much. And with that, we'll be adjourned for the day. Thank you all. 655 01:44:00,370 --> 01:44:03,084 Thank you. Thank you. Bye-bye. Thank you,