Fresno City Employees Health & Welfare Trust ... - City of Fresno

ADMINISTRATION OFFICE

MAILING ADDRESS

621 Santa Fe TELEPHONE (559) 499-2450 P.O. BOX 45018

Fresno, CA 93721 FAX (559) 499-2460 FRESNO, CA 93718-5018

Fresno City Employees Health & Welfare Trust

Agenda for the Regular Board Meeting

March 8, 2017

8:00 AM

Location: HealthComp 621 Santa Fe, Fresno CA 93721*

Employer Trustees-City of Fresno Employee Trustees Bruce Rudd, Vice Chairperson Shane Archer, Chairperson FFA Michael Lima, Trustee Jacky Parks, Trustee FPOA Jeffrey Cardell, Trustee Apolonio Munoz, Trustee ATU William Dearsan, Trustee

Martin Hinojosa, Trustee IBEW FCEA

Administrator Robert Mesel, Trustee CFPEA Tom Georgouses, Executive Vice President Shelley Morrison, Trustee CFMEA Michelle Bugg, Plan Manager Mike Alforque, Trustee FFA Marina Magdaleno, Trustee Local 39 Jo Billings, Trustee FPOA Vacant FAPSS

Legal Counsel Consultants

Michael E. Moss, Esq. Jim Rhein Rael & Letson

Roll Call 8:00 A.M.

1) Approval of Agenda**

Approve Agenda for March 8, 2017

Action as required

2) Approval of the Minutes

Approve Minutes of January 11, 2017

Action as required

3) Public Discussion***

4) Correspondence

a) The University of California at Berkeley Wellness Letter

5) Presentation of Administrator’s Report

a) Claim and Benefit Reports

b) Specific Stop-Loss Report

c) Turnaround Time Report

d) Open Enrollment materials for the 2017/2018 Plan Year

Review and approve open enrollment materials for the 2017/2018 Plan Year

Action as required

Fresno City Employees March 8, 2017 Health & Welfare Trust Regular Board Meeting Agenda 2

6) Review & Approval of Appeal Interpretations, Report from Appeals Committee

7) Presentation of Reports from Managed Care Vendors

a) Blue Shield of California

i) Cologuard Update

b) Psy-Care

Review of the February 2017 Utilization Reports

c) United Healthcare

d) Optum

i) Executive Summary

Review of the January 2017 Executive Summary

ii) Prior Authorization Report

Review of the February 2017 Prior Authorization Report

iii) EGWP Open Enrollment

Consider and Approve Moving EGWP Open Enrollment Date

Action as required

e) Delta Dental

Review of the January 2017 Experience Reports

f) ChiroMetrics

Review of the February 2017 Intake Reports

g) PhysMetrics

Review of the February 2017 Intake Reports

h) MES Vision

i) Teladoc

Review of the January 2017 Utilization Reports

8) Presentation of Consultant’s Report

a) Financial Projections for the 2017-2018 Fiscal Year

Review of the Financial Projections for the 2017-2018 Fiscal Year

b) Cost Analysis Report for the Requested Benefit Changes for the 2017-2018 Fiscal Year

Review of the Cost Analysis Report and Approve the Requested Benefit Changes for the 2017-2018 Fiscal Year

Action as required

c) Contribution Rates for the 2017-2018 Fiscal Year

Consider and Approve Contribution Rates for the 2017-2018 Fiscal Year

Action as required

d) Proposed Plan Document Changes for the 2017-2018 Fiscal Year

Consider and Approve Proposed Plan Document Changes for the 2017-2018 Fiscal Year

Action as required


e) Surrogacy Coverage

Discuss and Clarify Surrogacy Coverage

Action as required

f) Vendor Rate Submissions

i) HealthComp Agreement

Review and Approve HealthComp’s Eighth Addendum to Administrative Services Agreement

Action as required

ii) Rael and Letson Agreement

Review and Approve Rael and Letson Agreement

Action as required

g) Retain Prescription Benefits Consultant

Consider and Approve Consultant

Action as required

h) Mental Health Network – Request for Proposal

Consider and Approve Request for Proposal for Mental Health Network

Action as required

9) Proposed Agenda Format

Consider and Approve Proposed Agenda Format

Action as required

10) Attorney’s Report

a) Affordable Care Act

Update on the Affordable Care Act

11) Board Meeting Schedule

Action as required

12) Executive Session Items

a) Report on Subrogation Claim

CLOSED SESSION – CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATION Paragraph (4) of Subdivision (d) of Section 54956.9

13) Future Agenda Items

14) Adjournment

Action as required *The meeting room is accessible to the physically disabled. If you require a disability related modification or accommodation to participate in the meeting, notify HealthComp Administrators at (559) 499-2450.

** All writings, including Agendas, distributed prior to or during any Regular or Special Meeting are available for public inspection during regular business hours at the offices of HealthComp Administrators located at 621 Santa Fe, Fresno CA.

***Provides an opportunity for members of the public to address the Board of Trustees on items of interest to the public within the Board of Trustees jurisdiction and which are not already on the Agenda. It is the policy of the Board of Trustees not to answer questions impromptu but refer such matters to the Administration Office for placement on the next Agenda. Speakers should limit their comments to no more than three (3) minutes. No more than ten (10)


minutes per issue will be allowed. For items which are on the Agenda for this meeting, members of the public will be provided an opportunity to address the Board of Trustees before a vote is taken on each item.

NOTICE APPEALS COMMITTEE

Next Meeting: Monday, April 3, 2017 at 4:00 p.m.

Committee Members to Attend: Jeffrey Cardell, Robert Mesel, William Dearsan

~8~~11t.lll~111"" rn!!;;;;~;~~4~~ CITY EMPLOYEES

621 Santa Fe. Strcc[ Fresno, CA 93721

HEALTH AND WELFARE TRUST


0 Health Comp Third Party Administration

TELEPHONE (559) 499-2450 FAX (559) 499-2464

MAILING ADDRESS P.O. BOX 45018

FRESNO, CA 93718-5018

FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST MINUTES OF THE REGULAR BOARD MEETING

January 11, 2017

CALL TO ORDER: The regular monthly meeting of the Board of Trustees for the Fresno City Employees Health & Welfare Trust was called to order by Chairperson Shane Archer at 8:08 A.M., Wednesday, January 11, 2017 in the Conference Room at 621 Santa Fe Street. A quorum was present including the following:

EMPLOYEE TRUSTEES PRESENT: Shelley Morrison Jacky Parks Shane Archer Marina Magdaleno Apolonio Munoz

EMPLOYEE TRUSTEES ABSENT: Martin Hinojosa

EMPLOYER TRUSTEES PRESENT: Jeffrey Cardell Bruce Rudd

EMPLOYER TRUSTEES ABSENT:

OTHERS PRESENT:

HealthComp Phil Musson Michelle Bugg Moss Law Firm Mike Moss

Rael & Letson Jim Rhein

ChiroMetrics/PhysMetrics Jeremy Oswald Stephan Albracht

Blue Shield of CA Linda Patron

Optum Terry Miller

UHC Jacqueline Cienfuegos Carlos Guzman Psy-Care Sandra Carnahan

Jo Billings Robert Mesel Mike Alforque William Dearsan

Michael Lima

Delta Dental Duab Xaochay

FORCE Cheri Detweiler

MESVision Mike Schell

Benefit Analyst, COF

II

Item 1 Approval of Agenda - A Motion was made by Trustee Jeffrey Cardell and Seconded by Trustee Marina Magdaleno to approve the Agenda. The Motion was unanimously approved.

Item 2 Approval of Minutes

Approve Minutes of November 9, 2016 - A Motion was made by Trustee Michael Lima and Seconded by Trustee Apolonio Munoz to approve the Minutes for November 9, 2016. The Motion was unanimously approved.

Item 3 Public Discussion - None

Item 4 Correspondence

a) The University of California at Berkeley Wellness Letter - Mr. Phil Musson referred the Board of Trustees to the University of California at Berkeley Well ness Newsletter.

Item 5 Administrator's Report

Mr. Phil Musson reviewed the following reports for the Board of Trustees:

a) Claim and Benefit Reports for six months ending December 31, 2016.

b) Specific Stop-Loss Analysis Report for the period of July 1, 2016 through June 30, 2017 which identified one individual that had exceeded the specific Stop-Loss deductible of $500,000. No individuals had exceeded a 50% specific Stop-Loss claims level.

c) Turnaround Time Report for the month of December 2016.

Item 6 Review & Approval of Appeal Interpretations - None

Item 7 Reports from Managed Care Vendors

a) Blue Shield of California - Ms. Linda Patron, Account Manager, was present and had nothing to report.

Ms. Sandra Brock, an employee of the City of Fresno, addressed Blue Shield of California's position regarding the Cologuard testing and stated she had provided additional details on the subject to Trustee Robert Mesal. Per direction of the Board of Trustees, this will be added as an agenda item for the next Board of Trustees meeting.

b) Psy-Care- Ms. Sandra Carnahan, a Psy-Care representative, was present and referred the Board of Trustees to the December 2016 Utilization Report.

c) United HealthCare- Mr. Carlos Guzman, Account Executive, was present and referred to the following item:

III

i) Pacific Union Dental/United HealthCare Renewal - Mr. Guzman referred the Board of Trustees to the United HealthCare Renewal letter for the period of July 1, 2016 through June 30, 2018. A Motion was made by Trustee Jacky Parks and Seconded by Trustee Jeffrey Cardell to approve the Renewal. The Motion was unanimously approved.

d) Optum - Mr. Terry Miller, Account Executive, was present and referred to the following items:

i) Executive Summary - Mr. Miller reviewed the Executive Summary for the period of December 2015 through November 2016.

ii) Prior Authorization Report - Mr. Miller reviewed the Prior Authorization report for December 2016.

e) Delta Dental - Ms. Duab Xaochay, Account Manager, was present and referred to the Board of Trustees to the November 2016 Experience Report.

f) ChiroMetrics - Dr. Stephan Albracht was present and referred the Board of Trustees to the December 2016 Intake Report.

g) PhysMetrics - Mr. Jeremy Oswald, Account Manager, was present and referred the Board of Trustees to the December 2016 Utilization Report.

h) MES Vision - Mr. Mike Schell, Vice President of Sales, was present and had nothing new to report.

Item 8 Presentation of Consultation's Report

a) Financial Projections for the 2017-2018 Fiscal Year - Mr. Jim Rhein reviewed the Financial Projections Exhibits A-F with six months of actual claims. Mr. Rhein stated that based on the current data, to end the Fiscal Year at four months of reserve the Plan would require a 3.5% rate increase. Mr. Rhein stated this does not include any changes to benefits.

After much discussion on tiered rate structures and providing Retirees with an option to enroll in Cooperative Insurance to assist in rate setting, it was decided that more information is needed to research these topics.

b) Cost Analysis Report for the Requested Benefit Changes for the 2017-2018 Fiscal Year - Mr. Jim Rhein stated that he has not received any proposed benefit changes for the 2017-2018 Fiscal Year and requested that any proposed benefit changes be submitted as soon as possible.

c) Contribution Rates for the 2017-2018 Fiscal Year - This item was discussed under agenda items 8a and 8b.

d) Submission of Request for Plan Document Changes for the 2017-2018 Fiscal Year- Mr. Jim Rhein requested that any proposed Plan Document changes for the 2017-2018 Fiscal Year be submitted as soon as possible.

IV

e) Submission of Vendor Rate Increase Request for the 2017-2018 Fiscal Year- Mr. Jim Rhein updated the Board of Trustees on the rate history of all current vendors. Mr. Rhein stated he has not received any vendor rate increases for the 2017-2018 Fiscal Year but that HealthComp would be submitting a rate pass.

After discussion on vendor rates, the Board of Trustees directed Mr. Rhein to obtain requests for proposals from other mental health vendors.

f) Retain Prescription Benefits Consultant - Mr. Jim Rhein explained the request to retain a Prescription Benefits Consultant for consultation on contract review, the bidding process and claims auditing. After much discussion the Board of Trustees directed Mr. Rhein to present recommendations for retaining a Prescription Benefits Consultant.

Item 9 Attorney's Report - Mr. Mike Moss updated the Board of Trustees on the Affordable Care Act.

Item 10 Board Meeting Schedule

a) Consider and Approve Modification to Board of Trustees Meeting Schedule - A Motion was made by Trustee Jeffrey Cardell and Seconded by Trustee Jacky Parks to cancel the February 8, 2017 meeting and to accept the 2017 Board Meeting Calendar with the option to cancel any future meetings as the Board deems suitable. The Motion was unanimously approved.

Item 11 Executive Session Items


CLOSED SESSION -CONFERENCE WITH LEGAL COUNSELANTICIPATED LITIGATION Paragraph (4) of Subdivision {d) of Section 54956.9

A Motion was made by Trustee Jeffrey Cardell and Seconded by Trustee Jacky Parks to commence a closed session for the purpose to receive advice from Legal Counsel on existing litigation. The Motion was unanimously approved.

After return from the closed session Mr. Mike Moss reported that the Board had retained Mr. Steve McQuillan for a subrogation matter subject to approval of an Engagement Letter.

Item 12 Future Agenda Items

a) Blue Shield of California Cologuard

b) Mental Health Vendor Request for Proposal

c) Prescription Benefits Consultant

v d) Proposed Agenda Reformatting

Item 13 Adjournment- A Motion was made by Trustee Marina Magdaleno and Seconded by Trustee Jeffrey Cardell to adjourn the Board of Trustees Meeting at 10:03 A.M. The Motion was unanimously approved.

Shane Archer, Chairperson Fresno City Employees Health & Welfare Trust

Phillip J. Musson, Administrator HealthComp

Date

Date

FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST

MONTHLY CLAIMS EXPERIENCE ANALYSIS MEDICAL AND PRESCRIPTION DRUGS

EIGHT MONTHS ENDING FEBRUARY 28, 2017

ACTIVES COBRA RETIREES

MEDICARE SUPPLEMENT SELF-PAY OVER 65

AVERAGE MONTHLY COST· YTD

PRIOR YEAR AVERAGE MONTHLY COST- YTD EIGHT MONTHS ENDING FEBRUARY 28, 2016

PRIOR PLAN YEAR AVERAGE MONTHLY COST JULY 2015- JUNE 2016

TWELVE MONTH ROLLING AVERAGE March 1, 2016 - February 28, 2017

$ 21,612,538.59 32,002.59

2, 193,138.62

$ 23,837,679.80

$ 1,005,044.39 196,865.84

$ 25,039,590.03

$ 3,129,948.75

$ 2,799,865.35

$ 3,002,592.34

$ 3,222,647.95

Prepared by HealthComp Inc 03/01/2017

PER ELIGIBLE

$

$

$

$

$

$

$

$

900.45 1,882.51 1,185.48

921.48

778.50 1,081.68

915.79

915.79

843.59

901.14

948.44


MONTHLY CLAIMS EXPERIENCE ANALYSIS DENTAL BENEFIT SECTION

EIGHT MONTHS ENDING FEBRUARY 28, 2017

DELTA DENTAL

ACTIVES RETIREES

TOTAL FOR DELTA DENTAL

AVERAGE MONTHLY COST PUD HMO AVG MONTHLY PREM

TOTAL AVG MONTHLY COST- YTD

PAYMENTS

$ 1,589,081.36 262,253.75

$ 1,851,335.11

$ 231,416.89 15,532.14

$ 246,949.03

PRIOR YEAR AVERAGE MONTHLY COST: DELTA DENTAL JULY 2015- JUNE 2016

ACTIVES

RETIREES

COMBINED

TWELVE MONTH ROLLING AVERAGE DELTA DENTAL

March 1, 2016 - February 28, 2017

Prepared by Health Camp 03/01/2017

PER ELIGIBLE

$ $

$

$ $

$

$

$

$

$

74.62 67.56

73.53

73.53 40.70

69.98

74.50

40.70

70.62

74.29

Fresno City Employees H & W Trust

\

Average Cost Per Participant Monthly

Fresno City Employees H & W Trust Mar 16- Feb 17

1150 1100 ~. -~·-

1050 ' 1000

950 f---·· 900 +-850 -' --800 ' -- ·-·-~-.

750; ---~

700 + 650 ~-600o ·~ -~

M A M J J A S 0 N D J F

Health Camp Administrators

\ i

Average Cost Per Participant Year to Date

Fresno City Employees H & W Trust Jul16- Jun 17

1000

:~~ ~··-~ .~. ~-. . .:=.=.:::·~·~_===c::c:::··:=::;:::: 850 +-800 ! ---- . ·---~-

750 +---· --. ·--~ 700 ! ·-·- --. --~

650 ~.-600 ;

J A S 0 N D J F M A M J

He a lthComp Admin lstrators

1

Fresno City Employees H & W Trust

1000 I"

900 i 800

700

600

Average Cost Per Participant 12 Month Rolling Average

Fresno City Employees II & \V Trust Jun 97- Jan 17

" _____ " _____ ---H- l~~i..r./\1

t'\.~tf ---------- ·t--- - -----..,..r"!!::·~~ .. ..-c"'"''--------

.... /' ...... :~~ .... ·'"~'~.?';;;;·'"··'""·i,:.,;l- -------

300 1 ""{-._ .. ---"""'~

HeallhCompAdmioistrators

2

CATEGORY ACTIVES

PPO Contributing PPO Non-Con! 25 PPO Non-Cont 35 PPO Non-Cont 32 TOTAL (a)

RETIREES PPO Plan TOTAL

COBRA PPO Plan TOTAL

MEDICARE SUPP PPO Plan

TOTAL

SELF-PAY PPO Plan TOTAL

Stop-Loss Reimbursement

ACA TRP Payment


FINANCIAL ANALYSIS FOR MEDICAL, VISION AND PRESCRIPTION DRUG EIGHT MONTHS ENDING FEBRUARY 28, 2017

CENSUS CLAIMS FIXED TOTAL NET COUNT COSTS COSTS COSTS RATE INTEREST GAIN(LOSS)

2,461 $ 1,015.74 $ 78.98 $ 1,094.72 $ 1,{)90.00 4.21 {0.51) 47 $ 806.76 $ 78.98 $ 885.74 $ 854.80 4.21 (26.73) 37 $ 172.87 $ 78.98 $ 251.85 $ 737.20 4.21 489.56

455 $ 345.17 $ 78.91> $ 424.15 $ 773.00 4.21 353.06 3000 $ 900.37 $ 78.98 $ 979.35 $ 1,033.89 $ 4.21 $ 58.75

231 $ 1,185.48 $ 78.98 $ 1,264.46 $ 1,090.00 4.21 (170.25) 231 1,185.48 78.98 1,264.46 1,090.00 4.21 (170.25)

2 $ 1,882.51 $ 78.98 $ 1,961.49 $ 1,111.80 4.21 (845.48) 2 $ 1,882.51 $ 78.98 $ 1,961.49 $ 1,111.80 $ 4.21 $ (845.48)

161 $ 778.50 $ 69.62 $ 848.12 $ 607.00 $ 4.21 $ (236.91) 161 $ 778.50 $ 69.62 $ 848.12 $ 607.00 $ 4.21 $ (236.91)

23 $ 1,081.68 $ 78.98 $ 1,160.66 $ 1,315.00 $ 4.21 $ 158.55 23 $ 1,081.68 $ 78.98 $ 1,160.66 $ 1,315.00 $ 4.21 $ 158.55

$

$ $

$ $

$ $

$

$

TOTAL _$

NOTES: Claims Costs and Census Count represent average per month over the reporting period. Fixed Costs include all plan costs for Blue Shield, Psy-Care, ChiroMetrics, Optum, HealthComp, Rael & Letson, Moss Law Firm, MES, PhysMetrics and BCS Insurance

Interest revenue is based upon $14,400 per month, and has been entirely allocated to the above benefits. Rates are calculated on an average basis over the reporting period. (a) Total Claims Cost and Rate are based upon a weighted average of contributing and non-contributing.

Prepared by HealthComp 03/01/2017

YTD GAIN(LOSS)

(1.Q,.Q40.88) (10,050.48) 144,909.76

1,285,138.40 1 ,409,956.80

(314,963.12) (314,963.12

(13,527.68) (13,527.68)

(305,140.08' (305,140.08'

29,173.20 29,173.20

388,009.72

(176,887.73)

1,016,621.11


----------------

CENSUS CATEGORY COUNT

Delta PPO 3147

PUD HMO 382

TOTAL

NOTES:

FINANCIAL ANALYSIS FOR DENTAL EIGHT MONTHS ENDING FEBRUARY 28, 2017

CLAIMS FIXED TOTAL COSTS COSTS COSTS RATE INTEREST

$ 73.53 $ 4.96 $ 78.49 $ 86.00

$ - $ 40.70 s 40.70 $ 86.00

NET GAIN(LOSS)

$ 7.51

$ 45.30

Claims Costs and Census Count represent average per month over the reporting period. All interest revenue has been allocated to Medical. Rates are calculated on an average basis over the reporting period.

Prepared by HealthComp 03/01/2017

YTD GAIN(LOSS)

$ 189,071.76

s 138,436.80

$ 327~508.56

INCURRED: 07/01/16 THRU: 06/30/17 PAID: 07/01/16 THRU: 12/31/17

OVER $500 000 00 '


SPECIFIC STOP LOSS THROUGH 2/28/17

DEDUCTIBLE: $175k, $350k & $500k CARRIER: BCS Insurance Company

MEMBER NET PAID CLAIM AMOUNT 1 $ 888,402.43 $ 388,402.43 2 $ 562,053.41 $ 62,053.41

$ 1,450,455.84 $ 450,455.84

50% OVER $250 000 00 ' MEMBER NET PAID STILL TO MEET

$ -

$ - $ -

PREMIUM CLAIMS OVER

DEDUCTIBLE PER MEMBER PREMIUM DEDUCTIBLE SA VINGS/(LOSS) 175,000 $ 45.17 $ 1,168,547.90 $ 1 '122,606.48 $ (45,941.42 350,000 $ 16.57 $ 428,665.90 $ 750,455.84 $ 321,789.94 500,000 $ 9.69 $ 250,680.30 $ 450,455.84 $ 199,775.54

PRIOR YEAR RESULTS MEMBERS SA VINGS/(LOSS) $500 SA VINGS/(LOSS) SA VINGS/(LOSS) $175

FISCAL YEAR OVER$175K DEDUCTIBLE $350 DEDUCTIBLE DEDUCTIBLE 2008/2009 5 $ 275,694.78 $ 823,731.16 $ 1,333,752.01 2009/2010 11 $ 298,037.47 $ 660,094.16 $ 696,657.85 2010/2011 7 $ 571,249.08 $ 901,645.80 $ 2,451,452.16 2011/2012 12 $ 392,141.96 $ 562,653.55 $ 1,543,342.62 2012/2013 4 $ 690,024.10 $ 1 '115,261.30 $ 3,286,763.75 2013/2014 11 $ 892,384.76 $ 1,450,290.57 $ 3,807,297.67 2014/2015 11 $ 546,018.60 $ 941,346.55 $ 3,782,202.62 2015/2016 13 $ 324,590.15 $ 264,268.88 $ 374,381.62

TOTAL 74 $ 3,990,140.90 $ 6,719,291.97 $ I 7,275,850.30

PAID CLAIMS LAG TIME ANALYSIS Incurred: 01/01/1990-02/28/2017 I Paid Dates: 02/01/2017-02/28/2017

FRESNO CITY EMP H&W TRUST SUMMARY

RANGE OF INCURRED DATE RECEIVE DATE PROCESS DATE DAYS LAGGED TO RECEIVED DATE TO PROCESS DATE TO PAID DATE

Claims[ %Total! %Cum Claims[ %Total[ %Cum ciaimsl %Total[

0-7 1,358 16.0% 16.0% 8,175 96.4% 96.4% 8,328 98.2%

8-14 2,872 33.9% 49.9% 69 0.8% 97.2% 152 1.8%

15-21 1,231 14.5% 64.4% 28 0.3% 97.5% 3 0.0%

22-28 668 7.9% 72.3% 2 0.0% 97.5% 0 0.0%

Over 28 2,354 27.7% 100.0% 209 2.5% 100.0% 0 0.0%

TOTAL II OF CLAIMS: 8,483

AVERAGE DAYS FROM INCURRED TO RECEIVED: 39.9

AVERAGE DAYS FROM RECIEVED TO PROCESSED: 2.3

AVERAGE DAYS FROM PROCESSED TO PAID: 4.6

AVERAGE DAYS FROM RECEIVED TO PAID: 6.8

Underwrltar{s): 100 1 Group(s): 200 1 Product{s): All 1 Network(s): All

%Cum

98.2%

100.0%

100.0%

100.0%

100.0%

RECEIVE DATE TO PAID DATE

Claims[ %Total[

7,062 83.2%

1,140 13.4%

47 0.6%

22 0.3%

212 2.5%

Report PdCimsl.ag RUN TIME: 3f21201712:08:04 PM PAGE1 OF1

%Cum

83.2%

96.7%

97.2%

97.5%

100.0%

HEALTH & WELFARE FY17 HEALTH & WELFARE TRUST ACTIVITY REPORTPREPARED BY FINANCIAL REPORTING SCHEDULE OF RECEIPTS AND DISBURSMENTS

JULY 1, 2016 THRU DECEMBER 31, 2016 Period 6

RECEIPTS: JUL AUG SEP OCT NOV DEC TOTALS

CITY AND EMP. CONTRIBUTION FROM PAYROLL $3,627,969 $3,280,253 $3,286,079 $3,215,495 $3,030,696 $3,719,824 $20,160,316RDA EMPLOYEES CONTRIBUTION $2,352 $2,352 $0 $4,704 $2,352 $2,352 $14,112SELF PAY - LWOP $1,111 $634 $0 $1,428 $0 $317 $3,489SELF PAY - COBRA $3,528 $1,176 $1,176 $1,176 $2,352 $4,704 $14,112SELF PAY - FPOA ACTIVE ADM STAFF $4,704 $4,704 $0 $9,408 $4,704 $4,704 $28,224RETIREES $359,853 $363,369 $365,353 $363,156 $364,060 $362,791 $2,178,581RETIREES - HRA $77,566 $79,663 $0 $157,724 $74,319 $78,348 $467,620RETIREES - CITY PAID H&W RECEIPTS $0 $0 $0 $0 $0 $0 $0RETIREES - SELF PAY $6,820 $5,644 $0 $11,288 $5,644 $5,644 $35,040REFUNDS $10,107 $33,790 $63,292 $890,758 $1,986 $97,987 $1,097,920INTEREST $17,659 $18,632 $18,664 $17,303 $16,776 $17,716 $106,751OTHER $0 $0 $0 $0 $0 $0 $0 H & W TRUST CASH RECEIPTS $4,111,667 $3,790,218 $3,734,564 $4,672,440 $3,502,889 $4,294,387 $24,106,165

DISBURSEMENTS:

CLAIMS PAID ($3,012,910) ($3,642,529) ($2,988,434) ($3,149,438) ($3,619,498) ($3,153,262) ($19,566,069)CLAIMS PAID - DELTA DENTAL ($238,853) ($291,180) ($215,825) ($222,605) ($227,418) ($243,694) ($1,439,576)BLUE SHIELD OF CALIFORNIA ($59,379) ($59,795) $0 ($59,845) ($59,862) ($60,529) ($299,410)CHIROMETRICS INC ($3,243) ($10,524) $0 ($10,813) ($10,442) ($10,560) ($45,583)DELTA DENTAL OF CALIF. ($15,837) ($15,852) $0 ($15,887) ($15,956) ($16,095) ($79,628)REFUNDS ($1,176) ($1,350) $0 ($2,488) $0 ($4,778) ($9,792)RITE AID CORP $0 $0 $0 $0 $0 $0 $0NATIONAL MEDICAL HEALTH CARD $0 $0 $0 $0 $0 $0 $0CATAMARAN/OPTUMRX ($3,377) ($16,284) ($518) $0 ($7,903) ($3,954) ($32,037)PSY CARE $0 ($10,515) ($11,328) ($10,875) ($10,865) ($10,988) ($54,570)UNITED HEALTHCARE INSURANCE ($15,832) ($15,140) $0 ($15,547) ($15,588) ($15,140) ($77,249)OTHER - CLAIMS $0CITY ADMIN. FEES ($130) $0 ($260) ($130) ($130) ($130) ($780)ADM - REAL & LETSON ($5,650) ($5,650) $0 ($5,650) ($5,650) ($5,650) ($28,250)HEALTHCOMP INC. ($95,640) ($123,707) $0 ($96,392) ($96,418) ($97,492) ($509,648)LEGAL - MOSS TUCKER CHIU HEBESHA & WARD ($5,700) ($2,850) $0 ($2,850) ($2,850) $0 ($14,250)MES VISION ($56,902) ($57,390) $0 ($55,742) ($57,490) ($57,305) ($284,828)OTHER - ADMIN FEES $0 ($36,473) ($32,898) ($91,693) ($37,903) ($31,938) ($230,904) H & W CASH DISBURSEMENTS ($3,514,629) ($4,289,240) ($3,249,262) ($3,739,955) ($4,167,972) ($3,711,516) ($22,672,574)

RECEIPTS OVER DISBURSMENTS $597,038 ($499,022) $485,302 $932,485 ($665,083) $582,871 $1,433,591

JUL AUG SEP OCT NOV DECBEGINNING CASH BALANCE $20,390,471 $20,977,675 $20,525,320 $20,712,729 $21,649,754 $20,970,719

ADD: TOTAL REVENUE $4,111,667 $3,790,218 $3,734,564 $4,672,440 $3,502,889 $4,294,387 $24,106,165LESS: TOTAL EXPENDITURES ($3,514,629) ($4,289,240) ($3,249,262) ($3,739,955) ($4,167,972) ($3,711,516) ($22,672,574)

LESS: CHANGE IN RECEIVABLE $5,878 ($5,391) ($2,093) ($4,540) $13,952 ($2,585) $5,221LESS: CHANGE IN VOUCHERS PAYABLE $3,956 ($41,276) $299,986 $0 $0 $0 $262,666

$20,977,675 $20,525,320 $20,712,729 $21,649,754 $20,970,719 $21,556,175$20,390,472 $587,203 ($452,355) $187,409 $937,025 ($679,035) $585,456

ENDING CASH BALANCE $20,977,675 $20,525,320 $20,712,729 $21,649,754 $20,970,719 $21,556,175

ACCUMULATED RECEIPTS & DISBURSEMENTSJUL AUG SEP OCT NOV DEC

YTD CASH RECEIPTS $4,111,667 $3,790,218 $3,734,564 $4,672,440 $3,502,889 $4,294,387YTD CASH DISBURSEMENTS ($3,514,629) ($4,289,240) ($3,249,262) ($3,739,955) ($4,167,972) ($3,711,516)

YTD CHANGE IN RECEIVABLE $5,878 ($5,391) ($2,093) ($4,540) $13,952 ($2,585)YTD CHANGE IN PAYABLE $3,956 ($41,276) $299,986 $0 $0 $0

YTD NET CHANGE IN CASH $587,204 ($452,355) $187,409 $937,025 ($679,035) $585,456

CHANGE IN RECEIVABLEBEGINNING RECEIVABLE BALANCE $102,249 $108,127 $102,736 $100,643 $96,103 $110,055INCREASE, DEBITS $17,659 $18,632 $18,664 $17,303 $16,776 $17,716 $106,751DECREASE, CREDITS ($11,780) ($24,024) ($20,757) ($21,843) ($2,824) ($20,301) ($101,530)ENDING RECEIVABLE BALANCE $108,127 $102,736 $100,643 $96,103 $110,055 $107,470

ENDING RECEIVABLE BALANCE $108,127 $102,736 $100,643 $96,103 $110,055 $107,470BEGINNING RECEIVABLE BALANCE $102,249 $108,127 $102,736 $100,643 $96,103 $110,055CHANGE IN RECEIVABLE $5,878 ($5,391) ($2,093) ($4,540) $13,952 ($2,585)

CHANGE IN PAYABLEBEG VOUCHERS PAYABLE BAL ($262,667) ($258,711) ($299,986) ($0) ($0) ($0)DECREASE, DEBITS $266,693 $315,431 $344,729 $309,123 $320,926 $314,430 $1,871,332INCREASE, CREDITS ($262,736) ($356,707) ($44,743) ($309,123) ($320,926) ($314,430) ($1,608,665)END VOUCHERS PAYABLE BAL ($258,711) ($299,986) ($0) ($0) ($0) ($0)

END VOUCHERS PAYABLE BALANCE ($258,711) ($299,986) ($0) ($0) ($0) ($0)BEG PAYABLE BALANCE ($262,667) ($258,711) ($299,986) ($0) ($0) ($0)CHANGE IN VOUCHERS PAYABLE $3,956 ($41,276) $299,986 ($0) $0 $0

HEALTH & WELFARE TRUST ACTIVITY REPORTCASH BALANCE ANALYSIS

JULY 1, 2016 THRU DECEMBER 31, 2016 Period 6

10100 Equity in Pooled Cash 20,390,471.70 24,223,205.92 23,057,502.62 21,556,175.0010400 Treasury Interest Receivable 102,248.79 106,750.56 101,529.78 107,469.5720100 Vouchers Payable -262,666.61 1,871,332.08 1,608,665.47 0.0020318 H & W City Emp Trust W/H Paybl -8,079,745.17 24,452,838.73 25,779,678.86 -9,406,585.3025300 Unreserved/Undesignated -12,150,308.71 12,150,308.71 0.00 0.0030101 Transfer from Fund Balance 0.00 0.00 12,150,308.71 -12,150,308.7136101 Interest 0.00 0.00 106,750.56 -106,750.56

Total: 51504 Health Self-Insurance 0.00 62,804,436.00 62,804,436.00 0.00

Tot Subfund: 51500F Risk Management 0.00 62,804,436.00 62,804,436.00 0.00

Tot Fund Type: 50000F Internal Service 0.00 62,804,436.00 62,804,436.00 0.00

City of FresnoReport ID: ZGLS0010 TRIAL BALANCE BY DETAIL FUND Page No. 1

Run Date 01/19/2017Run Time 14:10:02

As of Year 2017 and Period 006Fund Type: 50000F Internal ServiceSubfund: 51500F Risk ManagementDetail Fund: 51504 Health Self-Insurance

Account Description Beginning Balance Debit Credit Ending Balance

DELTA DENTAL OF CALIFORNIA NETWORK UTILIZATION REPORT BY APPROVED AMOUNT (Excluding Orthodontics) FRESNO CITY EES HEALTH & Group Number: 00273

Delta Dental PPO

Delta Dental Premier

Delta Dental PPO


Note: Benchmark based on statewide averages. Results may vary due to benefit design, industry, age and area location.

• Proc /1 k I Yr = Procedures Per 1,000 Enrollees Per Year

38,596

8,563

36,215

8,714

979

Delta Dental Actuarial

2/7/2017

DELTA DENTAL OF CALIFORNIA NETWORK UTILIZATION REPORT BY PAID AMOUNT (Excluding Orthodontics) FRESNO CITY EES HEALTH & Group Number: 00273

Delta Dental PPO


Delta Dental PPO


$1,989,281

$469,380

$1,854,709

$482,381

$52.12

$12.30

$50.79

$13.21


2/7/2017

DELTA DENTAL OF CALIFORNIA DISTRIBUTION OF SERVICES BY PAID AMOUNT BY NETWORK FRESNO CITY EES HEALTH & Group Number: 00273

Restorative {02000 • 02499) Endodontics {03000 • 03999) Periodontics (04000 • 04999) Oral Surgery (07000 • 07999) Miscellaneous (09000 - 09999)"

Subtotal

Crowns & lnlays/On!ays {02500 - 02999) Removable Prosthodon~cs (05000 • 05999) Implant Services (06000 • 06199) Fixed ProsthodonHcs {06200 • 06999)

Subtobl

RestoraHve (02000 • 02499) EndodontiCS (03000 • 03999) PerlodonHcs (04000 • 04999) Oral Surgery (07000 • 07999) Miscellaneous (09000 - 09999)"

Subtobl

Crowns & lnlays/Onlays (02500. 02999) Removable Prosthodontics (05000- 05999) Implant 5ervlces (0!3000 • 06199) Axed ProsthodontiCS (06200 • 06999)

Subtotal

• lndudes Anesthesb, Orug:s and Adjundlvo Gcnorol SCtv!cos

Delta Dental Actuarial 2/7/2017

DELTA DENTAL OF CALIFORNIA COST SAVINGS REPORT (Excluding Orthodontics) FRESNO CITY EES HEALTH & Group Number: 00273

2) Provider Discounts* $1,600,491 Other Savings** $662,851

Total Savings $2,263,342

3) Plan Pays $1,989,281

4) Patient Liability*** $955,696

2) Provider Discounts* $1,326,372 Other Savings** $637,067

Total Savings $1,963,439

3) Plan Pays $1,854,709

4) Patient Liability- $833,936

procedures

30.7% $148,043 12.7% $189,925

43.5% $337,968

38.2% $469,380

18.3% $365,793

28.5%1 $155,309 13.7% $145,754

42.2% $301,063

39.9% $482,381

17.9% $415,400

** Other Savings includes services not payable due to duplicate submissions and missing or invalid information.

12.6% 16.2%

28.8%

40.0%

31.2%

13.0%1 12.2%

25.1%

40.2%

34.7%

- Patient Liability includes non~covered and optional savings, coinsurance, maximums, deductibles and non--contracted provider fees.

$0 0.0% $22,690 11.5%

$22,690 11.5%

$50,375 25.5%

$124,815 63.1%

$0 0.0%1 $34,693 17.5%

$34,693 17.5%

$46,172 23.3%

$117,645 59.3%

$1,748,534 $875,465

$2,624,000

$2,509,037

$1,446,304

$1,481,681 $817,514

$2,299,195

$2,383,262

$1,366,981

Delta Dental Actuarial 2/7/2017

DELTA DENTAL OF CALIFORNIA DOLLAR-BANDED UTILIZATION REPORT (Excluding Orthodontics) FRESNO CITY EES HEALTH & Group Number: 00273

<= $399.99 4,354 70.1% $400 to $799.99 1,036 16.7%

$800 to $1,199.99 360 5.8% $1,200 to $1,599.99 213 3.4% $1,600 to $1,999.99 135

<= $399.99 4,362 71.7% $400 to $799.99 967 15.9%

$800 to $1,199.99 341 5.6% $1,200 to $1,599.99 200 3.3% $1 ,600 to $1 ,999.99

Note: Includes waiver for D&P, if applicable.


2/7/2017


Financial Projections Contribution Rates

2017/2018 Fiscal Year

(Presented at 3/8/17 Trust Meeting)

Fresno City Employees Health and Welfare Trust Projected Enrollment and Claims Costs

Active Medical Claims Prescription Drug Costs Vision Claims Dental Claims (Plans 1 & 2)

Reaular Retiree Medical Claims Prescription Drug costs Vision Claims Dents! Claims (Plans 1 & 2) •

• Den!81Ciahlllil cDSisaralorall Rellras&

Medicare SupDlement Medical Claims PJW;crlptlon Dmg Costs VIsion Claims

(Projacted) Claims

FV17-18

Eriollment: $22,928,297 12.473,549

2585803

$37,967,649

Pnljecled Trend:

Month'Y

3,010 $1,910,691

1,039,462

= $3,163,971

Medical Claims

Prescription Drug Costs

Qental Claims fPians 1 & 21

TOTAL

Emlllmant: $2,704,148

1,013,064

,.,.. $4,130,282

231 $225,346

84,422

,...., $344,188

Prclected Trend:

lllledical Claims


Dental C!aJma !p[,gns 1 & ?I

TOTAL

Enrollment: $580,299 1,093,513

$1,673,812

Projected Trend:

217 $48,358 91,128

$139,484

Medical Claims


TOTAL

(Actual of 8 montlls) i {Projection of 4 monlhs) , Claims

fMPM 0.0%:-:

$634.78 ' ,,.,, 11M

$1,051.15

FY16·17

Enrollment: $21 ,229,905

11,443,623

2443 622

$35,117,150

:~Projected Trend:

8% (• Medical Claims

Monthly

3,010 $1,769,159

953,635

203635

$2,928,429

9% ~ PresCiiptlon D!Vg Costs

~ ~ Qental Claims (plans 1 & 21

B.1%i TOTAL

0,()% ,

$975.52 . 385.46

,.,.. .. $1,489.99

Enrollment: $2,480,870

929,417 ,.,..,. $3,803,687

~Projected Trend:

9% · Medical Clslms

231 $206,739

77,451

~ $316.9n

g% ·; PresCiipllon Drug Costs

5% 'i Dents! Clalma !p[,gns 1 & 2)

8.6%h0TAL

0.0%!' Enrollment: $222.85 ~ $552,668

419.94 1,003,223

$842.78 $1,555,869

· Projected Trend:

5% :Medical Claims

217 $48,056

63,602

$129,657

9% • PresCiipllon Drug COW>

7.6%i TOTAL

Claims PMPM ex111-16

3.4%:' Emollmant: $587.76 t: $20,186,337

316.82 ~ 10,405,496 3,130

,..;, 2 308 690

$972.24 \• $32,903,653

? Actual Increases: 2% ;~ Medical Claims

MonthlY

2,911 $1,692,195

887,125

"" ~ $2,741,971

6% 0 Prescription D111g Costs

~J Dania! Claims !plans 1 & 21

3.2%;{TOTAL

-,2.1%" Enrollmant: $894.97 $2,638,974

335.29 (· 918,626 (1)

69.60 394697 $1,372.17 • $3,952,298

~;Projected Trend:

-4% :~ Medical Claims

236 $219,915

76,552 (D) .....,

""·"' 3% (; P!l!Bcrlpt!on Drug Cost&

2% ~Dental Claims !Plans 1 & 2l -1.1%::.TDTAL

-2.3%~ Enrollment: 222 $212.24 .- $565,674 $47,140

385.26 F 1,020,474 85,040 ..,., @>1 $5g7.50 - $1,585,769 $132,147

Prujected Trend:

D% Medical Claims

1% Prescription D!Vg costs

DA% TOTAL

Claims PMPM FY14-1fi

1.S%C; Enrollment: $577.88 :· $22,098,033 297.88 8,705,079

0.09 428,929 66.09 2062664

$941.93 $33,294,705

~:Actual Increases:

·10% c; Medical Claims

Monthly

2,656 $1,841,503

726,423 35,744

171889 $2,774,559

17%; Prasaiption Drug Costs

;:,l Vision Claims

Wi' penfal C!p!m!!,!plpns 1 &2)

-3.0% 'TOTAL

.0.8%:: En!l:lllmenl: 239 $931.84 ·.' $2,288,176 $190,681

324.37 695,088 57,924 (0.00) 31,176 2,598 .... 378924 am

$1,395.59 :' $3,393,364 $282,780

~-- Projaeted T1110d:

16%!-iMedlcal Claims

33% t! Prescrlpllon D!Vg costs '"VIsion Claims

12%\' Dlllnla1Cialms!p!ans1 &21

17.5% ~TOTAL

-1:t3%t Enrollment: 253 $212.34 :~- $557,293 $46,441

383.08 1,510,292 125,85B {Q.H)_·. .1Mll 1.m

$596.28 $2,064,108 $173,676

_-. Prujaeted Trend:

16% ; Medical Claims

-23%. Prescription Drug Casts

. ~!!I!CJalms

-13.3%. TOTAL

PMPM

1.7% ....... ,. 254.00

12.52

§Q.jj_ ~-$971.48 ~'

Claims FY13-14

Enrullmenl: $18,113,034

7,431,077 835,914 ~

$28,350,751

~~ Actuellncreases:

20% i~ Medical Claims

Monthly

2,807 $1,50g,42o

619,256 52,993

180594

$2,382,583

15% !! Prasa1pllon Drug Costs

-34% ~Vision Claims -7%f]DMfal Claims !plans 1 &2J

15.4%:jTOTAL

-9.2%i Enrollment: $801.18 $3,594,253

2A3.3B 881,961 10.92 52,269 §1Jl!! 2'94 465

$1,188.15 $4,902,948

;) Projected Trend:

-30% ~~Medical Claims

"' $299,521 71,830

4,358 = $408,579

-11% il Prescription O!Vg Casts

-34% t VIsion Claims

m_ ~ [l!mtaJ CIBI!!I!!j (p1QD§1 & 2)

-23.8%etTDTAL

-4.2%f-~ Enrcllment: $183.56 $507,418

497.48 :· 1,367,930 5.44 ZM1§

$666.46 :; $1,898,963

"'Projected Trend:

15% ; Medical Clsims

264 $42,285 113,994 ~

$158,247

15% ' Prescription Drug Costs

-27%'~

14.5%: TOTAL

Exhibit A (Presented at 3/8/17 Trust Meeting)

Claims PMPM fY12-13

9.1%( Enru\lment $537.73 i, $15,301,094

220.81 _: 6,182,618 18.88 ;· 688,552 64.44 - 1.i1l.1£l

$841.67 •• $23,964,007

cjActuall!lCIDSes:

9% ~Medical Clalma

Month'Y

2,573 $1,275,091

615,218 47,379

159312

$1,997,001

10% :! PresOOpt!on Drug Costs

3% t~ VIsion Claims

~~Dental Claims !plans 1 & 2l 8.4%f,iTOTAL

-8.8%:; Enrullment: 261 $1,143.21 $4,768,728 $397,227

274.18 914,495 76,208 16.63 "·"" 4,692 59.66 ~ ......

$1,559.48 $6,132,904 $511,075

'Projected Trend:

-19%i_ Med!eaiC!alms

1%C: Prescription DIU{] Costs

0% ;. Vision Claims

:lli ~De!Jiel Cle!ms IP[,gnB 1 & 21 -14.3% ;fTOTAL

-a.D%i $160.17 :·

431.80 ;

I&' $599.42 -

Enrollmenl: $530,662 1,508,046 = $2,065,711

Projected Tren~:

5% ;, Medical Claims

290 $44222 125,671

g.g§Q

$172,143

0%: Prescription Drug Costs

~ · Vision Claims

1.0%; TOTAL

PMPM

5.1% 1: $495.57 :-·

200.24 ; 18.41 ~§!B:o

$776.14 '

-1%~ -2%:;· 9%''

~r -0.6%:-:

-8.0'!1il· $1,413.62 _.

271.20 ' 16.70 ....

$1,818.77

17%

-5%~ -2%~; ~(

12.5%';

-2.0%~: $152A9 : 433.35 -

LJj_

$593.80 .

6%'

13%:

~~J 11.3%;

H:\C~en191A-L\I'CYH\1-I'RE JAN 1 2017\0M~II Projacllons\Ann\1111 Projee!loni2017-1&W! Exhibits (March 8 2017)

"""'"

Fresno City Employees Health and Welfare Trust Projected Enrollment and Claims Costs

{Actual of 8 months) (Projected) :: (Projec:tlon of 4 months)

Claims Claims Claims FY17-18 Monlhlv PMPM EY..1§,U - ....... """"' -

Non-Medjcar§ B§tiree Enrollment: 23 Enrollment: 23 Enrollment: 23 Medical Claims $321,876 $:!.6,823 $1,166.22 $295,299 $24,809 $1,069.92 292,774 $24,398 VIsion Claims Q Q

$321,876 $26,823 $1,168.22 $295,299 $24,608 $1,069.92 ' $292,774 $24,398 • Rx Is InCluded !n RegullfRatl""'s

;; Projected Trend: Projected Trend: ·,: Projected Trand:

Medical Claims "' _;-Medical Claims 1%' Medical Claims

TOTAL 9.0% "TOTAL 09% ·TOTAL

Total Members Enrollment: 3,461 0.0%;:: Enrollment: 3,481 2.6%"; Enrollment: 3,392 Medical Claims $26,534,620 $2,211,218 $635.23 r: $24,556,740 $2,046,562 $587.92 . $23,683,759 $1,973,647 Pn~scriptlon Drug Costs 14,580,126 1,215,010 349.04 - 13,378,2&2 1,114,889 320.22 • 12,344,598 1,028,717 Vision Clelme 2,750 229 Dental Claims (Plans 1 & 2) ~ 248238 71.31 2837003 236A17 67.92 ;; 2703387 ''"" $44,093,599 $3,674,467 $1,055.58 $40,772,004 $3,397,667 $976.06' $38,734,494 $3,227,875

Projected Trend: Projected Trend: 1%~

Projected Trend: Medical Claims 8% Medical Claims Medical Claims Prescription Drug Cos!s 9% Prescription Drug Costs 6% i Prescription Drug Costs

Dental Claims IEI!!ll1 i 2} a llan!!!l QI!!I!I!§ !Pien1 ] I ~ ~:· R!!nt!!l Claims (EJ~s 1 1!21 TOTAL 8.1% TOTAL 2.6% ·TOTAL

Claims

""""' ,__,.,. -

Enrollment: 26 $1,060.78 f. 463,529 $38,627

0.00 !i g,m 244

$1,060.78 ~- ....... 6 $38,871

i'i ~> Prnjec:ted Trand:

-29% j; Medical Claims

;~~ -29.0% f.· TOTAL

0.6% Enrollment: 3,373 $581.85 $25,407,031 $2,117,253

303.28 10,910,459 909,205 0.07 479,553 39,963 .... ~ 203466

$951.61 $39,238,631 $3,269,886

Projected Trend: -7% Medical Claims 13% Prescription Drug Costs

VIsion Claims ,.,. l:!!i!!ll!i!l Qlllm!i! lEI!!D!i! 1 I 2l -1.8% TOTAL

Exhibit A {Presented at 3/8/17 Trust Meeting)

Claims Claims

""""' FY13-14 MonthLy PMPM .EY.1M! - ....... Enrollment: 25 Enrollment: 22

$1,485.67 . 236,243 $19.687 $787.48 $277,055 $23,088 $1,049.45 9.38 :' ~ "" 1M! "" ,. 3.41

$1,495.05 $239,536 $19,961 $798A5 $277,955 $23,163 $1,052.86

:;; Projected Trend: Projected Tl&fld:

"" \Medical Claims -25% Medical Claims -16%

~ VIsion Clelms -~IIQI!!;;!IIDJII :§ill;. 87.2%," TOTAL -24.2% TOTAL -16.3%

OA% Enrollment: 3,358 Enrollment 3,166 3.3%···

$$27.71 $22,450,948 $1,870,912 $557.15 $20,675,539 $1,739,628 $549.47 ' 269.56 9,660,968 805,081 239.75 8,605,169 717,097 228.50 '

11.86 715,091 59,591 17.75 652,764 54,397 17.18 ·.· ..... ......,., . 213766 63.66 ~ 192280 §!ill. $969.43 $35,392,198 $2,949,350 $878.31 $32,440,577 $2,703,381 $Sfi3.88 ::

Projected Tlll!ld: Projected Trend: 2%;: 13% Medical Claims 1% Medical Claims

12% Prescription OIUg Costs 6% Prasalpllon DIUg Costs -1%0' -33% VIsion Claims 3% VIsion Claims 8% -5% Da!Jisl Q!lllms (Plans 1 & 2} ,.. 1:!01 Qjgims IPI!!D!i! l I ill ~~

10.4% TOTAL 2.9% T07Al 1A%

H:\Cllen!8\A-LIFCVH\1-PREJAN 1 2!l17V\nnual P~<~]eollonMnnuol Projection• 2017-18WI Exl11blls {Man:h a 2017) 3 """"

. Fresno City Employees Health and Welfare Trust Receipts and Disbursements FY 2015-2016

1 City C<lntlibutlollll ·ActiWa 2 RDA ErnpiDyeP ContrtbuUan 3 Selfl'ay·LWOP 4 Self Pay. coBRA 5 Self Pay. FPOA Pollee Admin 81all' ........ 7 RatirHs·HRA B Ratlftu·CityPald 9 Ratfrap.Salr-Pay

10 Rafunda 11 lnltorul 12~

H & W Trust Cash Receipts

Disbursements

1 Claims Paid 2 BIUB Shield of callfamla 3 a.ln11nelrlas, IM. 4 Delta o.n1a1 of Cll.llfamla

·-~ ,_ .. 7 NMHC 8 catamaran Rx 9 PayCire

10 UnlbldHealth Dental 11 Olhar·CiabnB 12 City Admin F ... 13 Co1111u1t1ng 14 Healtlloamp, Ina. 15 Legal

MESVIolan KalserFaundatian Hultlll'llln -· H & W Cash Dlsbunsements

Receipts Over Disbursements

.... $9BUO

0.70

"' OA> 1.41

110.14

"'" 000 uo ,~

4.32

""' $1,121.29

1!69.81 18.10 o.go <M

'" .,, 000

"' '" 4.80 0.00 .... '$

28.13

·~ 18.75 ... 000

$1,048.44

$72.85

........ ro'~ $3.219.231 $:!B,eao,m

"" 28.224

·~ 8,131 1,372 """ '·"" 68,446

387,545 4,410,5:!8 81,282 976,381

0 0 7,325 ~.-

42,676 514,540

"- 172,799

' ' $3,741,766 $44,901,194

3.235,812 38,827,349 53,727 "'"0 3,01~ "''~ 15.340 184,076

"' "" '·"" 30,528

' ' 1,014 12,170

'·"' 117,296 16,012 192.1411

0 0

"' 1,430 5,850 .,..., -.= 1,128,478

2.613 31,3!10 55,909 670.908

' • ""' """

$3,498,663 $41,983,956

$243,103 $2,917,238

C.all S.la-{G"'"' Fund RMerve) Cb""''B In Ri!cehlablea

Chr!"R!! IQ \(gu•h•m PDqb!p SubTotai(CUh Bahlnce)

aalma IBNR(61311J115 Awll1J Nat Fund Bahlnoa

CUh S.lance I Total ExpanHs NRI Fund Balmce I Total ~n .. a

~· ~· ~· ~· ""' - S•p!!mbl~ --$3,475,760 $3,176,431 $3,160,754 $3,2.10,513 2.161! ''" 2,352 2,352 ~ "' •• "" • • • 1,176

4,704 4,704 <'M 4,704 371,628 372.934 374.540 373.619

62,027 84,048 68,978 82,093

• " 0 0 8,651 8,495 ··= 7,996

18,994 28,296 • 20,408 11,623 12.428 13,607 14,444

' ' ' ' $3,976,724 $3,690,426 $3,670,307 $3,717,939

$3,363,900 $3,081,768 $3,147,940 $2,625,916

"·"' • 105,005 52,972 2,974 • 5,941 2,991

15,237 " 30,608 14,989

" 1,175 '" 1.860

• • • • " •

'" 3.173 3.453 9,640 • 19,282 9,717

16.321 • 29,996 15,361

• • " " '" '" '" "' 6.660 5,850 5,650 5,650 92,283 • 185,898 96.797 2,650 2,850 2,850 2,850

66.078 110.174 55,793

• • • ' " '

$3,617,711 $3,072,176 $3,848,977 $3,088,185

$369,013 $618,250 $23,330 $629,754

$17,825,353 $19,447,282 $19,217,745 $19,094,616 $4,691 $2.036 "'~' ($8,058}

fWlOl """" """"" """" $17,629,032 $16.1M.415 $18,484,882 $10,112,1)86

""""""' """"""' """""" ~ $13,929,032 $14,294,41~ $14.584.882 $15.212.088

'·' 02 '' " ... ... " ..

Exhibit B (Presented at 3/8/17 Trust Meeting)

~· ''" ''" ~· ~· 'MO 20f8 ~· - - - - .... ""' "" -$3,193,081 $3.211.654 $3.233.757 $3,239.884 $3,250,793 $3,276,338 $3,251,gQ3 $2.929,905

2,352 2,352 2,352 "'" ""' 2.352 2.352 2,352 1,186 ~· ·~ "" "" ·~ "' 1,109 1.178 "" 1,178 • 4,704 • '·"' 3,526

• 9,408 4,704 4,704 •. ~ 4,704 4,704 4,704 370,531 365,995 362,875 369.001 3-56,436 3-5S,551 359,919 362,507

83.722 79.072 80,892 79,516 78,632 78.722 80,636 79,241

• 0 • 0 • • • • M44 7,996 5,644 7,996 6,820 7,996 6,820 8,820 n,..,.. 57,401 16,380 13,388 17,726 11.431 11,586 248.904 16,652 14,402 14,491 14,947 14,578 14,004 16.222 15,195

' ' ' ' ' ' ' ' $3,747,388 $3,771,266 $3,722,711 $3,722,402 $3,739,379 $3,751,574 $3,738,813 $3,664,265

$3,033,624 $3,112,5llfl S2.871,ns $2,992,839 $3.656.992 $3,405.387 $3.420,922 $3,933,791 52,721 53,023 53,325 • 53,392 53,577 54,131 114,021

2.983 " 6,017 3,021 • >WO "'' 8,152 0 18,2.02 30,663 • • 30,896 • 46.490

1,468 1,693 "" " 30,528

• • no ... " "" • 2,845 9,671 9.7Zl 9.782 " 19.623 9.930 19,1146

15,385 16,038 15,670 15.954 16,199 16,788 33,465 0 0 " 0 • •

"" "' "' "" "' "' 5,850 5,850 • 11,300 • 5,650 5,850 11,300 92.606 93,089 93.599 93,599 " 93.921 94,915 190,769 2,850 2,850 • 5,700 2.850 2,650 "~ 0

55,289 55,860 55,961 • 66,414 56,314 55,810 113,215

• " " • " 0 ~ ' ""' ' ' ~

$3,272,937 $3,366,200 $3,136,91& $3,143,104 $3,78&,932 $3,688,278 $3,664,299 $4,601,242

$474,450 $406,006 $585,796 $579,298 ($48,663) $63,296 $72,514 ($846,977)

$19,566,637 $19,891,029 $20,542,489 $21,146,348 $20,938,236 $20,912,8!11 S20,99B,702 $20,136,626 $7.~09 $3,527 $9,247 ($4,830) ($7,939) ($1,643) $3.305 $8.816 ~ !ID.:!!11 """"" """" m!W. ...,

~ ......,

$19.465,963 $19,956,593 $20,569,046 $20,984,799 $20,849,555 $20,9Z4,168 $20,983,603 $20,390.475 1$3900 000) """"""' ~ """"""

...,.,.. ~ - """"""" $15,6115,963 $16,058,693 $16,669,048 $17,084.789 $16,949,555 $17,024,188 $17,063,603 $16,490,475 .. . 5.7 •.. 0.0 ... •• ... .. "' .. .. ... .. .. ..• .,

Fresno City Employees Health and Welfare Trust Receipts and Disbursements FY 2016-2017 (Projected)

Receipts

ConbibUtiona ~Actives RDA EmpJoyeea Contribution Self Pay - LWOP Self Pay - COBRA Self Pay - FPOA Pollee Admin Staff Retlraea - Health Retirees - HRA Retlreas • Salf.Pay Refund& ,......, ""'" H & W Trust Cash Receipts

Disbursements

Claims Paid Claims Paid - Delta Dental Blue Shield Chlrometrlcs Delti. Dental of California ....... Flu Shot Pragam OptumRx Pay Care United Dental City Admin Feaa Consulting Healthcomp, Inc. ..... , MESVIBTon Other f!JCS StoP Loaalnsl H & WCash Disbursements

Receipts Over Disbursements

~5 1l2I&. $39,759,301

2,155 25,854 595 7,145

1,390 16,680 4,309 51,708

362,965 4,355,575 72,352 868,229

5,951 71,414 35,182 422,189 18,530 222,355 31,973 383,871

$3,848,677 $46,184,121

3,174,594 38,095,124 239,467 2,873,610 59,515 714,174

3,622 43,467 15,557 186,689

1,044 12,526 2,583 31,000 2,432 29,179

10,154 121,843 15,498 185,972

130 1,560 5,671 68,050

97,446 1,169,:347 3,0116 37,050

57,024 684,292 43196 m.m

$3,731,021 $44,772,284

$117,658 $1.411667

Cash Bslanr;;e (Grasa Fund Reserve) Stop Loss Reserve ($16 PEPM)

EeUmated Claims IBNR (6130116 Audit) Net Fund Balance

Cuh Balance 1 Total Expenses Net Fund Balance I Total Eltpenses

.... JJiJ!l

$3,627,969 2,352 1,111 3,526 4,704

359,BS3 77,566

6,820 10,107 17,659

Q

$4,111,669

$3,012,910 238,853

59,379 3,243

15,837 1,176

0 3,377

0 15,832

130 5,650

95,640 5,700

56,902

• $3,614.629

$597,040

$20,977,675 ($48,240)

~ $17,029,435

5.6 4.6

2018

'""""' $3,280,253 2,362

6'4 1,176 4,704

363,369 79,663

5,644 33,790 18,632

• $3,790,217

$3,642,529 291,180

59,795 10,524 15,852

1,350 0

16,284 10,515 15,140

0 5,650

123,707 2,850

57,390

~ $4,289,239

($499,022)

$20,525,320 ($96,450)

""'-"Jl2l!l $16,528,670

5.5 4.4

ProJecUons: .. .. _, $3,286,079

0 0

1,176 0

365,353 0 0

63,292 18,664

• $3,734,664

$2,988,43 215,82

4

' 0 0 0 0 0 6 51

11,328 0

26 0 0 0 0 0

' 3 """' $3,249,26

$486,30 1

$20,712,729 ($144,87 5)

0 -$16,888,054

.6 5 4 .5

.... Qctobar $3,285,000

2,350 600

1,200 4,700

353,000 79,000

6,550 35,000 18,600

• $3,796,000

$3,181,250 236,417 119,000

3,300 31.000

2,000 0

1,000 20,000 31,000

130 11,300

190,000 5,700

$114,000 -$3,992,097

($196,097)

$20,516,632 ($192,885)

~ $16,423,747

5.5 4.4

2016

~ $3,285,000

>350 600

1,200 4,700

363,000 79,000

8,550 35,000 18,800

• $3,799,000

$3,181,250 236,417

59,500 3,300

15,600 1,000

0 1,000

10,000 15,500

130 5,650

95,000 2,850

$57,000 WQO

$3,897,097

$98,803

$20,615,535 ($241,650)

~ $16,473,885

5.5 4.4

.. .. ~

$3,285,000 2,350

600 1,200 4,700

363,000 79,000

8,550 35,000 18,800

• $3,796,000

$3,161,250 238,417

59,500 3,300

15,500 1,000

0 1.000

10,000 15,500

130 5,650

96,000 2,850

$57,000 33000

$3,697,097

$98,903

$20,714,438 ($290,835)

~ $18,523,603

5.6 4.4

2017 2017 2017 Janllllrv - Momh $3,2BS,000 $3,285,000 $3,285,000

2,350 2,350 2,350 600 600 600

1,200 1,200 1,200 4,700 4,700 4,700

383,000 363,000 363,000 79,000 7s,ooo· 79,000

6,550 6,550 8,650 35,000 35,000 35,000 18,600 18,500 18,800

• ~ • $3,798,000 $4,179,671 $3,798,000

Exhibit C (Presented at 3/8/17 Trust Meeting)

2017 2017 2017 - .... .till!< $3,285,000 $3,285,000 $3,285,000

2,350 2,350 2,350 600 600 600

1,200 1,200 1,200 4,700 4,700 4,700

363,000 363,000 363,000 79,000 79,000 79,000

6,550 6,560 8,550 35,000 35,000 35,000 18,600 18,600 18,600 • Q Q

$3,796,000 $3,796,000 $3,786,000 • Step tellS Rt!lm!IU'semenl

$3,161,250 236,417

59,500 3,300

15,500 1,000

0 1,000

10,000 15,500

130 5,850

96,000 2,950

$57,000 152000

$3,916,097 • TlU' Payment

($20,097)

$20,894,:341 ($:340,155)

~ $16,454,188

5.5 4.4

$3,161,250 $3,161,250 $3,161,260 $3,161,250 $3,181,250 236,417 236,417 236,417 236,417 238,417

59,500 59,500 59,500 59,500 59,500 3,300 3,300 3,300 3,300 3,300

15,500 16,600 15,500 15,500 15,600 1,000 1,000 1,000 1,000 1,000

31,000 0 0 0 0 1,00Q 1,000 1,000 1,000 1,000

10,000 10,000 10,000 10,000 10,000 15,500 15,500 15,500 15,500 16,500

130 130 130 130 130 5,650 6,650 5,650 5,650 5,900

95,000 95,000 95,000 95,000 95,000 2,950 2,850 2,850 2,850 2,950

$57,000 $57,000 $57,000 $57,000 $57,000 = 33 000 """"' ,.. ~ $3,728,097 $3,897,097 $3,697,097 $3,697,097 $3,697,347

$461,674 $98,903 $98,903 $98,903 $88,653

$21,145,915 $21,244,818 $21,343,721 $21,442,824 $21,541,277 ($388,806) ($437,055) ($485,505) ($533,955) ($582,405)

~ ~ - ~ W!l:OOOO!Jl $16,857,310 $16,907,783 $16,958,216 $17,008,669 $17,056,872

5.7 5.7 5.7 5.7 5,6 4.5 4.5 .. ••• 4.6

31212017 f+.\Cr.enia\A-L\FCYH\1-PRE JAN 1 2017\Annllal Pnljeclions\Annual Projecllons 2017-18\AII E:<hlblla {March a 2D1n

esno City Employees Health and Welfare Trust 1ceipts and Disbursements 2017-2018 (Projected)

tributlons ·Actives rees -Health reas ·Dental lndS ... " w Trust cash Receipts

1bursements

nsPald ns Paid - Delta Dental tShleld 1 and Chlromeb1cs 1 Dental of California 1nds lhotProgam omRx c ... tel Dental Admin Fees suiting thcomp, Inc.

" iVIalon 1r fSmp Loss Ins\ W Cash Disbursements

!lpts Over Dlsbun~ements

~ TOTAL $3,384,253 $40,611,038

392,028 4,704,336 39,732 476,784 30,000 360,000 10,000 120,000

0 0

$3,8158,013 $46,272,156

3,428,229 41,114,746 248,236 2,978,853

54,618 655,414 10,925 131,098 15,956 191,476 1,000 12,000 2,917 35,000 1,000 12,000

10,515 128,161 15,385 184,615

130 1,560 5,650 67,800

101,526 1,218,309 2,850 34,200

57,355 688,262 35000 420 000

$3,989,293 $47,871,514

__j$_'!33 280 ($1699359

Cash Balance (Grosa Fund Resarva) Stop Loss Reserve ($15 PEPM)

Estimated Claims IBNR (6130/15 Audit) Net Fund Balance

Cash Balance I Total Expenses Nat Fund Balance I Total Expanaes

-0.0%

2017 -$3,384,253 392,028

39,732 30,000 10,000

• $3,858,013

$3,426,229 248,238 54,616 10,925 15,956 1,000

0 1,000

10,515 15,385

130 5,650

101,526 2,850

57,355 35 000

$3,988,376

($130,363)

$21,410,914 ($630,855) ~

$16,880,059

6.4 4.2

2017 2017 2017 2017 - - - N!!!!!llllll! $3,384,263 $3,384,253 $3,384,253 $3,384,253

392,028 392,028 392,028 392,028 39,732 39,732 39,732 39,732 30,000 30,000 30,000 30,000 10,000 10,000 10,000 10,000

• • • • $3,868,013 $3,81i8,013 $3,~56,013 $3,858,013

$3,426,229 $3,428,229 $3,426,229 $3,426,229 248,238 248,238 248,238 248,238

54,818 54,818 54,818 54,618 10,925 10,925 10,925 10,925 15,956 15,956 15,95£1 15,956 1,000 1,000 1,000 1,000

0 0 0 0 1,000 1,000 1,000 1,000

10,515 10,515 10,515 10,1515 15,385 15,385 15,385 15,385

130 130 130 130 5,650 15,650 5,650 5,650

101,526 101,528 101,526 101,526 2,850 2,850 2,850 2,850

$57,355 $57,355 $57,355 $57,355 35 000 35 000 = 35.000

$3,986,378 $3,988,376 $3,986,376 $3,986,376

($130,383) {$130,353) ($130,363) ($130,363)

$21,280,551 $21,150,188 $21,019,825 $20,889,461 ($879,305) ($727,755) ($776,205) ($824,855)

{13 90000[1 ~ ($3 900 COOl ~ $16,701,248 $16,522,433 $1 8,343,620 $16,184,806

5.3 5.3 5.3 5.2 4.2 4.1 4.1 4.1

ExhibitD (Presented at 3/8/17 Trust Meeting)

2017 2018 2018 2018 2018 2018 2018

~ - - Mamh - M!!J<

"""" $3,384,263 $3,384,253 $3,384,253 $3,384,253 $3,384,263 $3,384,253 $3,384,253 392,028 392,028 392,0.28 392,028 392,028 392,028 392,028 39,732 39,732 39,732 39,732 39,732 39,732 39,732 30,000 30,000 30,000 30,000 30,000 30,000 30,000 10,000 10,000 10,000 10,000 10,000 10,000 10,000

• • • • • • • $3,858,013 $3,856,013 $3,856,013 $3,868,013 $3,858,013 $3,856,013 $3,8!6,013

$3,428,229 $3,428,229 $3,426,229 $3,426,229 $3,426,229 $3,426,229 $3,426,229 248,238 248,238 248,238 248,238 248,238 248,238 248,238

54,618 54,618 54,818 54,618 54,618 54,818 54,816 10,925 10,925 10,925 10,925 10,925 10,925 10,925 15,956 15,956 15,956 15,956 15,956 15,956 15,956 1,000 1,000 1,000 1,000 1,000 1,000 1,000

0 0 35,000 0 0 0 0 1,000 1,000 1,000 1,000 1,000 1,000 1,000

10,515 10,515 10,515 10,515 10,515 10,515 10,515 15,365 15,385 15,385 15,385 15,385 15,385 15,385

130 130 130 130 130 130 130 5,650 5,850 5,650 5,650 5,6150 5,650 5,650

101,526 101,526 101,526 101,526 101,1526 101,528 101,526 2,850 2,850 2,8150 2,850 2,650 2,850 2,850

$157,355 $57,355 $57,355 $57,355 $57,355 $57,355 $57,365 35 000 ~ 35 000 35 000 ~ ~ = $3,988,376 $3,988,376 $4,021,376 $3,986,376 $3,988,376 $3,986,376 $3,985,378

($130,383) ($130,363) ($165,363) ($130,353) ($130,363) ($130,353) ($130,353)

$20,759,096 $20,628,735 $20,463,372 $20,333,009 $20,202,646 $20,072,282 $19,941,919 {$873,105) ($921,555) ($970,005) {$1,018,4515) ($1 ,066,905) ($1,115,355) ($1,163,805) ~ {13 900 00[1 !Ia "!H! !;!!!ID ~ {13 900 000\ ~ ~ $15,985,993 $15,807,180 $15,593,387 $16,414,554 $15,235,740 $15,056,927 $14,878,114

5.2 6.2 5.1 5.1 6.1 5.0 5.0 4.0 4.0 3.9 3.9 3.8 3.8 3.7

One Month of Avg Expenses In 2017118: $3,989,293

Esllmatad Fund Balance as of 6/30118: $14,878,114 El;!!I[Months of Avg 5lm!r!!!IS ill .gQjz/18: lli.i§IJZ1

Difference: ($1 ,079,058)

(, 312/2017

H:\Cjlenta\A.L\FCYH\1-PRE JAN 1 20t71Annual Projectlona'Aimuall'ro)l!ctlo"$2017-18\AII Exl!lbllll (March 8 2017)

esno City Employees Health and Welfare Trust •ntribution Rate Calculations r Contributions beginning July, 2017

4 Months Reserve 4.1 Months Reserve Unencumbered BtHk Even (Dol/siS)

July, 2016 2.0% Additional 3.6% Additional - - - Increase Amount

tive lth +Dental $1,176 $1,200 $24 $1,217 $41

gular Retiree lth +Dental $1,176 $1,200 $24 $1,217 $41 tal Only $86 $88 $2 $89 $3 lh $1,090 $1,112 $22 $1,128 $36

dicare Supolement lh $557 $568 $11 $576 $19 ilh+Denlal $643 $656 $13 $665 $23 tale is fi:Jr the Meclicllre Supplement ro!iree only. 'Cid a Spouse, the Rile is 2x the llbove lli/e)

n-Medicare Retiree lh $1,315 $1,341 $26 $1,361 $46 lth +Dental $1,401 $1,429 $26 $1450 $49

,11 Dollar amounts are rounded to the next whole dollar.

Exhibit E (Presented at 3/8/17 Trust Meeting)

4.6 Month Reserve 5 Months Reserve Break Even (Reserve) Unencumbered

7.6% Additional -8.0% Additional 11.0% Additional Increase - . .., ..... Amount lncreas• Amount

$1,264 $88 $1,105 ($71) $1,305 $129

$1,264 $88 $1,105 ($71) $1,305 $129 $92 $6 $81 ($5) $95 $9

S1.1n $82 $1,025 ($65) $1,210 $120

$599 $42 $524 ($33) $618 $61 $691 $48 $604 ($39) $714 $71

$1,414 $99 $1,460 $145 $1 506 $105 $1,555 $154

7 H:\CiienlsJA.LlJ=CYH\1-PRE JAN 1 2017\Annual PllljootionsV\nnual Projeclkms 2011-18\Ail Exhibits (Marella 2017)

312/2017

tSno City Employees Health and Welfare Trust

ntributlon Rate

1-Jul-16 1.Jul-15 1-Jul-14 1.Jul-13 1-Jul-12 1-Jul-U 1.Jui-1D 1-Mar.O& ContrlbutiOII Contribution Contribution Contrlbutlan Conbibutlan Conbibutlan Contribution Contribution ... - .... - ... ... - ...

:lve lth+Oantal $1,1711 $1,1711 $1,084 $1,084 "" "" $911 '"' family) "" ·~

... "'·"" '·"' 8.1% ~-"" -1LS%

gular Blli!H lth+Oantal $1,178 $1,178 $1,084 $1,1184 "" "" "" "'' tal Only '" ... "' "' '" "' .. "' • $1,000 $1,000 $1,005 $1,(104 "" "" .... "'' ramiiYl "" .... '·"" "'·"' '·"" U% ~-"" -US%

d!care Suggl§:m!I:Dt llh+Danlal "" . ..... $5112 • "" . "" . "" . .. ... "'' • .. ~. "'' . $513 • $513 • "". "'' . "'' . '"' paman) '"" ... ... ..... "'' .... 13.3% -1L5% WPparlio'pO!I<In"'quiJB<I

n-Med!care Reli!!! llh+Oantal $1,401 """' $1.2111 $1,2111 $1,174 $1,174 $1,078 "" • 11,315 $1,315 $1,212 11,212 $1,102 $1,102 $1,011 "" ramnyJ '"' .... '·"' - . .. . ... 25.1% -us•

1.Jui-OB 1.Ju~07 ...... Contl1butlon Canlllbutlan Contribution ... ... ...

,,,. "" "" ·~ '·"' ~-"'

,,,. "" '"' "' '" '" '"' "" "'' 0.2% ... ~,.

"" .... .... "" '"' '"' '" ... 15.1%

''" "" '"' ''" '"' "" ... '"' 15.2%

Exhibit F (Presented at 318/17 Trust Meeting}

1.Jul-llfi 1.JuJ.04 1.Jui.Q3 '"""" 1-Jul-01 Contribution Contllbutlon Contribution Contribution Contribution ... ... - .... ...

$711 '"' .... "'' .... ... 13.2% . ... "·"' 16.1%

$711 '"' ..... $5911 ''" "" "' "' '" ... ... ,., "" "'' "" '"" "·"' '"' "·"" ~,.

"" "" "'' '"' ''" "" "" '"' "" ''" . .. 13.~% 15.4% 11.9% """

''" ''" "~ "'" "'" "" '"' "" ''" "" '"' 13.2% 5.1% "·"' 37.2%

H."\Ciel111\M.V'CVH\1.PREJAN 1 2017\olnnulll'to)~Projdono2D17-1BIAIExllilllt!I(Mil<h 82017) _,

EMAIL: [email protected] WEB: HALCYONBEHAVIORAL.COM

PROPOSAL FOR THE PROVISION OF AND MENTAL HEALTH AND

SUBSTANCE ABUSE (MHSA) SERVICES

PREPARED FOR:

FRESNO CITY EMPLOYEES

HEALTH & WELFARE TRUST MARCH 3, 2017

PREPARED BY:

1

HALCYON BEHAVIORAL MHSA MANAGEMENT SERVICES PROPOSAL

COMPANY FACTS

Name: Halcyon Behavioral Office: 2416 W Shaw Ave, Suite 106 Fresno, CA 93711

Office Phone: (855) HBI-4HLP Triage/Referral Phone: (888) HAL-4800 Web: [email protected] halcyonbehavioral.com

hal.cy.on

Adjective: Denoting an idyllically happy and peaceful period of time. Synonyms: quiet-calm-tranquil-peaceful-untroubled

ABOUT HALCYON BEHAVIORAL

Halcyon Behavioral was founded to provide Mental Health and Substance Abuse (MHSA) benefit administration, Employee Assistance Programs (EAP), and Health & Wellness Programs with a focus on quality, outcomes and transparency. Halcyon Behavioral offers a comprehensive and holistic approach to behavioral healthcare that is clinically responsive, fiscally sound and designed specifically for self-insured organizations. Through a confidential and comprehensive telephonic assessment, each member’s needs are immediately triaged and referrals to medically appropriate care are provided. Halcyon Behavioral works with a nationwide network of mental health providers, psychiatric programs and facilities, and substance abuse programs to ensure our members receive the highest quality care that meets their specific needs. Halcyon’s clinical team of psychiatrists, psychologists and master’s level clinicians provides targeted case management, utilization management, and quality assurance programs to ensure we achieve effective and efficient clinical outcomes.

2


HALCYON BEHAVIORAL: BENEFITS AND SERVICES Halcyon Behavioral helps organizations improve member health and decrease plan costs through an integrated suite of behavioral health and wellness programs. Halcyon offers a wide array of technology enhanced, innovative services to clients including:

Mental Health and Substance Abuse Benefit Administration: We provide complete mental health and substance abuse (MHSA) benefits to self-insured organizations through Halcyon Behavioral. Through a confidential and comprehensive telephonic assessment, each member’s needs are immediately triaged and referrals to medically appropriate care are provided.

Employee Assistance Programs: We offer solution-focused employee assistance and work-life programs through Halcyon EAP. We help our members confidentially manage personal problems that may affect job performance, while helping employers address employee emotional issues before they manifest into disruptions in the workplace.

Health & Wellness Programs: Our wellness programs help clients get healthier through health assessments, targeted intervention, proactive health coaching and engaging wellness-related competitions and challenges.

Introduction Quarterly Monthly

Introduction Quarterly Monthly

3


HALCYON BEHAVIORAL: MHSA PROGRAM Halcyon Behavioral would like to partner with the Fresno City Employees Health and Welfare Trust to provide MHSA administration. At the core of Halcyon’s service offering is our exceptionally caring and talented team and a robust technological infrastructure that allows us to operate efficiently, provide complete data and reporting transparency, and maintain the strictest member privacy and security. The services included in mental health and substance abuse benefit administration include:

Clinical Services Halcyon services are accessible to members 24 hours a day, every day of the year, via a dedicated toll-free telephone number. All calls are answered directly by a licensed masters- or doctoral level clinician, also known as a ‘Case Manager’. Our primary focus is to ensure members receive the behavioral healthcare services they need. A comprehensive intake/triage evaluation is completed for every member call and a referral to the most clinically appropriate provider, program, or facility is issued based on the individual’s unique needs and presenting issues. Multi-disciplinary referrals are also provided to address any co-morbid conditions/needs identified during interactions with each member.

Member Services Halcyon member service representatives are available to answer questions relating to eligibility, provider/facility network status and/or location, benefits including (but not limited to): covered services, limitations and exclusions, claims, grievances, denials, and appeals. They are also able to transfer callers immediately to obtain services outside the scope of the behavioral health benefit.

Case Management Case management focuses on careful review, outreach, and engagement for improved treatment compliance and positive clinical outcomes. Case management is critical in helping avoid re-admission to acute mental health hospitalization and/or substance abuse programs. Routine referrals for case management will include any members accessing facility-based treatment, and members with complex or chronic conditions. Our program offers individualized case review with an emphasis on multidisciplinary collaboration, building natural supports, and increasing enrollee participation to most effectively manage their illness.

Utilization and Quality Management Programs Halcyon Behavioral ensures enrollees receive medically necessary, clinically appropriate, behavioral healthcare, delivered in the least restrictive environment to achieve their optimal level of functioning. Effective treatment is based on an accurate assessment of an individual's need and access to appropriate services from qualified providers within the scope of their health plan benefits. Halcyon Behavioral’s team of psychiatrists and mental health professionals review care provided to members at every level, from outpatient to acute psychiatric hospitalization. Halcyon Behavioral reviewers make decisions using evidenced-based treatment guidelines in the administration of pre-certification, ongoing treatment monitoring/management, and clinical care evaluation to ensure members receive medically needed treatment while delivering operational effectiveness.

4


Network Management and Provider Relations Members have access to quality practitioners and facilities for all services provided. Our contracted providers complete a rigorous credentialing and re-credentialing process assessing and validating each provider’s qualifications, compliant with nationally established standards. The program includes monitoring provider performance indicators such as: adherence to evidenced-based techniques and modalities, appropriate utilization of services, availability of services when medically/clinically needed, and patient satisfaction.

Claims Administration Halcyon Behavioral provides our clients and members with claims administration that can include receiving claims submissions, verifying member eligibility, payment based on negotiated provider rates, provider dispute resolution processes, and electronic transmission of claims to Health Comp.

Care Integration Our licensed Clinical Case Managers are cross-trained to identify and refer members with comorbid health-related conditions to the appropriate type of care management program, such as Employee Assistance or general medical programs. The end result is a member profile that is holistic in nature; and a member that is receiving the right mode of care at the right time.

Data Collection and Reporting Halcyon Behavioral collects and reports trends and data that illustrate the impact of a client's MHSA benefit program. Our comprehensive reports are reviewed with clients on a regular basis. In addition, all encounter data and reports are transmitted regularly to entities as designated by the client.

5


KEY BENEFITS TO PARTNERING WITH HALCYON BEHAVIORAL

Customized Approach to Providing Mental Health and Substance Abuse Benefits “Treat the Person Not the Condition”

Significant Cost Savings

Flat PEPM Rate, no Additional Costs

Comprehensive Clinical Services o 24/7 Triage by Licensed Clinicians o Multi-disciplinary Clinical Team Lead by our Medical Director (Child and Adolescent Psychiatrist),

experienced in providing benefits to Trust members o Targeted Case Management

Comprehensive Provider Network that Starts in Fresno and Spans the Country

Robust Single-Source Database Transaction System o Enhanced Data Collection and Reporting o Integrated Claims, Clinical, Credentialing and Customer Service

Established collaboration and data exchange with Health Comp

Web-based Services o Member Website o Provider Portal o E-Connect Platform for Remote Services

Headquartered in Fresno

Capacity to add integrated suite of services in the future including EAP and Wellness

6


HALCYON BEHAVIORAL: MHSA PRICING Client: FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST Employees: 3,384

Pricing below is for MHSA administration of the Trust’s existing behavioral health benefit, and services as identified in this proposal.

Comprehensive Clinical and Needs Assessment

Halcyon Behavioral MHSA Administration o Clinical Services o Member Services o Case Management o Utilization & Quality Management o Network Management and Provider Relations o Claims Administration o Care Integration o Data Collection and Reporting

Halcyon charges on a Per Employee Per Month (PEPM) basis for the MHSA administration services listed in this proposal. Our service includes claims pricing for network discounts and utilization management, actual claims expense would be available after benefit application through Health Comp. This provides for transparent and accurate plan cost calculations.


MHSA Administration Services $2.50 PEPM

*Halcyon offers a 3 year rate guarantee.

7


SUMMARY By partnering with Halcyon Behavioral to manage the MHSA benefit, the Fresno City Employees Health & Welfare Trust will ensure that their members have advocates as they receive critical mental health and substance abuse benefits, have access to a comprehensive local network that spans the nation and recognize a cost savings.

CONTACT INFORMATION Our senior management is available at your convenience to answer any questions or to discuss the behavioral healthcare benefits in more detail. Address: 2416 W Shaw Ave, Suite 106 Fresno, CA 93711

Phone: (855) HBI-4HLP

Web: halcyonbehavioral.com

Jeremy Oswald Chief Executive Officer 559-400-6202 [email protected]

Amy Villegas, Ph.D. Chief Operating Officer 559-400-6203 [email protected]

EIGHTH ADDENDUM TO ADMINISTRATIVE SERVICES AGREEMENT

This Eighth Addendum to Administrative Services Agreement ("Eighth Addendum") is entered into this day of 2017, between the FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST ("Trust") and HEALTHCOMP, LLC formerly HealthComp, a California Corporation ("Administrator").

RECITALS

A. The parties previously executed an Administrative Services Agreement ("Agreement") dated May 30, 1996, which has been amended thereafter from time to time.

B. It is the desire of both the Trust and the Administrator to add to the Agreement this Eighth Addendum to extend the term of said Agreement through June 30, 2020 and to establish Administrator's compensation for the period of July 1, 2017 through June 30, 2020.

TERMS AND CONDITIONS

1. The Agreement shall be extended through June 30, 2020.

2. The Trust will pay Administrator as full compensation for its services rendered during the period of July 1, 2017 and June 30,2020, a monthly fee of twenty-six and 85/100 Dollars ($26.85), including all postage, for each employee or retiree for whom a Welfare contribution is received by the Trust.

3. Except as set forth above, the terms and conditions of the Agreement, as previously amended, shall remain in full force and effect, including all termination provisions contained therein.

IN WITNESS WHEREOF, the parties hereto have duly executed this Eighth Addendum on the day and year first above written.

HEALTHCOMP, LLC

By ____________________ __

President and CEO


By ________________ _

Shane Archer Chair and Employee Trustee

By __________ _

Bruce Rudd Vice Chair and Employer Trustee

Fresno City Employees Health and Welfare Trust Open Enrollment Verification/Change Form for the Fiscal Year July '17- June '18

P.O. BOX 45018 FRESNO, CA 93718-5018 0 (559) 499-2450

(800) 442-7247 FAX (559) 499-2464

April 28, 2017

«hfname» «hlname» «addr1 » «addr2» «City», «State» «Zip»

HealthComp"' ,~hlrd Party Administra-tors

Member ID#: Bargaining Unit:

XEL «cert» «dept»

You MUST RETURN this form to HealthComp by JUNE 1, 2017. INSTRUCTIONS: In order to be certain that we have the most current and accurate Information for your insurance coverage, please take a moment to verify the information above and below. If any of the information Is inaccurate or If you wish to make a change please write down the change next to the ltem(s) being changed • ''

EMPLOYEE & DEPENDENT INFORMATION •••

' ·,

!------··· ' ·--·--·-·----···--SOCIAL SECURITY NUMBER

REQUIRED FOR ALL RELATIONSHIP NAME DATE OF BIRTH PARTICIPANTS

«11reh> «11fname» «111name» «11dob» «11ssm>

«12rel» «12fname» «121name» «12dob» <d2ssm>

«13rel>> «13fname» «131name» «13dob» «13ssn>>

<<l4reh> <d4fname» «141name» «14dob» «14ssm>

«15reh> «15fname» «15Jname» «l5dob» <d5ssm>

«16rel» <<16fname>> «16lname» «16dob» «16ssm>

«17reh> «17fname>> «171name>> «17dob» «17ssm>

«18reh> «18fname>> «181name» «IBdob» «18ssn»

<d9reh> «19fname» «191name» «19dob» <d9ssm)

MEDICAL PLAN ELECTION . · . ... . ..

You are currently enrolled in «medbenefib>

0 I WANT TO CHANGE MY MEDICAL PLAN ELECTION TO: (IF YOU CHECK THIS BOX, THE REQUIRED FORM(S) WILL BE MAILED TO YOU)

0 PPO PLAN WITH FULL BENEFITS (EMPLOYEE CONTRIBUTION REQUIRED) 0 PPO PLAN WITH REDUCED BENEFITS (NO EMPLOYEE CONTRIBUTION REQUIRED)

IF YOU DO NOT CHECK TilE BOX, YOUR CURRENT PLAN AND CONTRIBUTION ELECTION WILL REMAIN IN EFFECT

. DENTAL PLAN ELECTION . . • . . ··· . - ··-·--·--·--·-·-· ·-~--

You are currently enrolled In: «denbenefib>

0 I WANT TO CHANGE MY DENTAL PLAN TO: (Check Box Below) *You MAY NOT elect the Un!tedHealthcare Dental HMO Plan

D Delta Dental PPO Plan 0 UnitedHealthcare Dental HMO Plan* unless the dental office you select Is accessible by both you and/or your covered dependents. No benefits will be paid for

OR services rendered by Non-Participating Providers.

0 I WANT TO DECLINE DENTAL COVERAGE

VISION PLAN ELECTION . ·. .

. • . . · . .

You are currently enrolled In: «vlsbenefib>

0 I WANT TO ADD VISION COVERAGE OR

0 I WANT TO DECLINE VISION COVERAGE ..

I

I DECLARATION UNDER PENALTY OF PERJURY, I DECLARE THAT THE INFORMATION PRESENTED ON THIS FORM, TO THE BEST OF MY KNOWLEDGE AND BELIEF, IS TRUE, CORRECT AND COMPLETE.

Signature Of Employee Date

Fresno City Employees Health and Welfare Trust P.o. sox

45018

Open Enrollment Verification/Chana for the Fiscal Year July '17- June '18

FRESNO, CA 93718-5018 Heal-thComp® Third !"'arty Administrators

(559) 499-2450 (800) 442-7247

FAX (559) 499-2464

April28, 2017

«hfname» «hlname» «addr1 » «addr2» «City», «Slate» «Zip»

Member ID#: Bargaining Unit:

XEL «cerl» «dept»

You MUST RETURN this form to HealthComp by JUNE 1, 2017. INSTRUCTIONS: In order to be certain that we have the most current and accurate information for your insurance coverage, please take a moment to verify the information above and below. If any of the information is inaccurate or if you wish to make a change please write down the change next to the item(s) being changed

' EMpLOYEE & OEpENDENT INFORMATION • •. ·.• . . ·.

SOCIAL SECURITY NUMBER REQUIRED FOR ALL

RELATIONSHIP NAME DATE OF BIRTH PARTICIPANTS

<d1reh> «11fname» <d11name» «11dob>> «11ssm>

«12rel» «12fname» <d21name» «12dob» <d2ssm>

«13rel» «13fname» «131name» «13dob» «13ssn»

«14rel>> «14fname» <d41name>> «14dob» <d4ssn»

«15rel>> «15fname» «151name>> «15dob» «15ssm>

«16reh> «16fname>> <d61name» «16dob» «16ssn»

«17rel» «17fname» «171name» «17dob» «17ssm>

«IBreh> «IBfname» <d81name>> «18dob» «18ssm>

«19reh> «19fname» «191name>> «19dob» '<19ssn»

DENTAL PLAN ELECTION ..

. : . . . . . :· ·.· c-------·-·- ------------·-------- " .. __ ·-

You are currently enrolled in: «denbenefl!»

D I WANT TO CHANGE MY DENTAL PLAN TO: (Check Box Below) *You MAY NOT elect the UnltedHealthcare Dental HMO Plan

D Delta Dental PPO Plan 0 UnitedHealthcare Dental HMO Plan* unless the dental office you select is accessible by both you and/or your covered dependents. No benefits will be paid for

OR seiV!ces rendered by Non-Participating Providers.

0 I WANT TO DECLINE DENTAL COVERAGE . VISION PLAN ELECTION . · ... · . ·. . ·.

..

. .· . .· ... You are currently enrolled In: «visbenefi!»

0 I WANT TO ADD VISION COVERAGE OR

0 I WANT TO DECLINE VISION COVERAGE

'

DECLARATION UNDER PENALTY OF PERJURY, I DECLARE THAT THE INFORMATION PRESENTED ON THIS FORM AND IN THE ACCOMPANYING DOCUMENTATION ARE, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, CORRECT AND COMPLETE.

Signature Of Employee Date

P.O. BOX 45018 FRESNO, CA 93718-5018

Fresno City Employees Health and Welfare Trust Other Insurance Information Questionnaire Form for the Fiscal Year July '17- June '18

0 He a I-t h Com p•

Third Po..-ty Administrator"

(559) 499-2450 (800) 442-7247

FAX (559) 499-2464

You MUST RETURN this form to HealthComp by JUNE 1, 2017 OTHER INSURANCE INFORMATION QUESTIONNAIRE

In order to fully document our system regarding other health insurance, it is required that you complete the following:

Employee Name, ___________________ _ Member ID# ___________ _

Do you or any of your covered dependents have other existing health coverage?

1:1 NO- Please sign and date at the bottom and return this form to HealthComp.

1:1 YES- Please provide relevant information for each additional Carrier/Plan providing other health insurance coverage for your family below.

Is your spouse also an employee of the City of Fresno? ClYes CJNo If yes, Name & ID#

#1: Carrier/Plan Name: ___________ Policyholder Name: ___________ DOB: ____ _

Plan Type (check one): 0 Employer 0 Medicare Part: A B C D 0 Medicaid 0 Individual 0 Retiree 0 Other _______ _ (circle alllhal apply)

Coverage type: 0 Medical 0 Dental 0 Vision 0 Rx Effective Date: _____ _ Termination Date: _____ _ (check all that apply) (if applicable)

#2: Carrier/Plan Name: ___________ Policyholder Name: ___________ DOB: ____ _

Plan Type (check one): 0 Employer 0 Medicare Part: A B C D 0 Medicaid 0 Individual 0 Retiree 0 Other ____ _ (circle all that apply)

Termination Date: _____ _

USING THE ABOVE CARRIER NUMBERS, PLEASE FILL OUT THE FOLLOWING INFORMATION FOR EACH COVERED DEPENDENT

Carrier _#_ Covered dependent (see above)

Relationship to policyholder

Is coverage court-ordered?

(it yes, allach relevant pages)

Yes No

Yes No

Yes No

Yes No

Yes No

Person with whom child primarily resides & their relationship to child

(II applicable)

Please list the Name and Date of Birth for all covered dependents who do not have other health insurance coverage:

Dependent name: DOB: Dependent name: DOB:

DECLARATION UNDER PENALTY OF PERJURY, I DECLARE THAT THE INFORMATION PRESENTED ON THIS FORM AND IN THE ACCOMPANYING

DOCUMENTATION ARE, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, CORRECT AND COMPLETE.

Signature of Employee:. __________________ _ Date: ________ _

Fresno City Employees Health and Welfare Trust Fiscal Year July '17- June '18

P.O. BOX 45018 FRESNO, CA 93718-5018

June 9, 2017

«FirstName» «LastName» «Address!» «Address2» «City» «State» «Zip»

Dear Plan Patticipant:

0 He a I "t h Com p®

Thlrcl Patty A.Jn•lnistrot=r,. (559) 499-2450 (800)-442-7247

The annual open emollment for the Fresno City Employees Health & Welfare Trust Plan was recently conducted. The elections made during this open enrollment will go into effect on July 1, 2017. You were mailed an open enrollment packet at the end of April2017. To date, we have either not received your response or have received only a partial response. The completion and return of the forms contained in the packet is required.

In an effort to accommodate all circumstances which may have prevented participants from returning their open emollment information, the Board of Trustees has provided a grace period through July 1, 2017, You are strongly encouraged to complete your open enrollment forms and return them to HealthComp Administrators by the grace period deadline.

Ce1tain information requested on the Open Enrollment forms is necessary for the accurate processing and payment of your health claims. It will therefore be necessary for us to hold payment of all claims submitted on your behalf for dates of service after June 30, 2017, until such time as we receive the completed Open Enrollment forms from you.

If you need another open enrollment packet, or assistance in completing your open enrollment forms, please contact HealthComp Administrators at (800) 442-7247.

We look forward to your reply,

THE BOARD OF TRUSTEES

Fresno City Employees Health and Welfare Trust Fiscal Year July· 17- June '18

P.O. BOX 45018 FRESNO, CA 93718-5018

July 13, 2017

«FirstName» «LastName» «Address1 » «Address2» «City» «State» «Zip»

Dear Plan Participant:

0 HealthComp®

Thl.-cl Party Adn>lnist~ot<;>r" (559) 499-2450 (800)-442-7247

The Fresno City Employees Health & Welfare Trust recently conducted an open enrollment for an effective date of July 1, 2017. Open enrollment material was sent to you at the end of April 2017. On June 9, 2017, a letter was mailed to you providing a grace period extension to July 1, 2017 for the return of your open enrollment forms.

To date, we have either not received your open enrollment material or have received only a partial response.

Certain information requested on the Open Enrollment forms is necessary for the accurate processing and payment of your health claims. It will therefore be necessary for us to deny payment of all claims submitted on your behalf for dates of service after June 30, 2017, until such time as we receive the completed Open Enrollment forms from you subject to all plan provisions.

You have the right to appeal this decision. You may appeal this decision by filing a written request for appeal to the Board of Trustees within (180) days of receipt of this notice.

Should you have any questions, please feel free to contact HealthComp Administrators at (800) 442-7247.

THE BOARD OF TRUSTEES

blue'- of california

Notice Informing Individuals about Nondiscrimination and Accessibility Requirements

Discrimination is against the law

Blue Shield of California complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Blue Shield of California does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

Blue Shield of California:

• Provides aids and services at no cost to people with disabilities to communicate effectively with us such as:

- Qualified sign language interpreters

Written information in other formats (including large print, audio, accessible electronic formats and other formats)

• Provides language services at no cost to people whose primary language is not English such as:

- Qualified interpreters

Information written in other languages

If you need these services, contact the Blue Shield of California Civil Rights Coordinator.

If you believe that Blue Shield of California has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

Blue Shield of California Civil Rights Coordinator P.O. Box 629007 El Dorado Hills, CA 95762-9007

Phone: (844) 831-4133 (TTY: 711) Fax: (916) 3/i0-7405 Email: [email protected]

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

Blue Shield of California 50 Beale Streel. San Francisco, CA 94105 blueshieldca.com

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You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue SW. Room 509F, HHH Building Washington, DC 20201 (800) 368-1019; TTY: (800) 537-7697

Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.

Language Access Services

English: For assistance in English at no cost, call1-866-346-7198.

Spanish (Espafiol): Para obtener asistencia en Espafiol sin cargo, llame al 1-866-346-7198.

Tagalog (Tagalog): Kung kailanganninyo ang libreng tulongsa Tagalog tumawag sa 1-866-346-7198.

Chinese <tJlX:l: :!<o*mWtJlX:B'g5EJI'tfWllJJ • ij!jt.l(:JT~1'-5W 1-866-346-7198.

Navajo (Dine): Dine k'ehji doo bl!l!h ilfnfg6 shika' at'oowol ninizingo, kwiji' hodiilnih 1-866-346-7198.

Vietnamese (Tiling Vi~t): ElMuqc h6 trq mi~n phi tiling Yi~t. vui long goi den so 1-866-346-7198.

Korean (B~Oj): B~OiS:.§OI~RofAI'i"!. 1-866-346-7198 .!f.lit!£f £t!£fof~AI2..

Armenian (i.mJhphu): i.mJhphlithqt[m.J.mut[l\mpoqumpJmhmnmlimtnthmtlmpjuliqpnul hu!lqmuqmhmpht 1-866-346-7198.

Russian (PyCCKf1i1): eCAI-1 H)I)KHa 6ecnAOTHa~ nOMOW.b Ha PYCCKOM ~3b1Ke, TO no3BOHV1Te 1-866-346-7198.

Japanese (E;;j;:~l§): E;;j;:~i§~jlf.J(~,~fo:Jj;~, 1-866-346-7198 l:::~~ili~i.J'It-c < t= ~ ~ '• I!!! ;f~ "C' tit f# L * '9.

Persian (<.<"".;U): ."J.JN l>'w 1-866-346-7198 <)ill •.;W 4 lu.J,""".;u u4J .:;~1.; .s...s c.i\;y c.>IY.

Punjabi(<.<!~):-J.fi JtS Ul.o c:? 1-866-346-7198 2 .fi .;4->t" .;1 >.>. i:iJ <.<!~

Khmer (Fil Mll§lll): ~·!lrummr.nnl•a"'"ru";,;g "'""""""'rus1-866-346-7198.

Arabic(~~!): .1-866-346-7198 :,.l)l 1:,. .)c. J\...o.>"4 J..:.il• ll4--> ~~I WI <) o.>cWI .)c. J_,...,.,J

Hmong (Hnoob): Xav tau kev pab dawb lub Hmoob, thov hu rau 1-866-346-7198.

Hindi(~): ~ .. <\)iif<l<ill ri 4iMI<l<114ifMQ, 1-866-346-7198 q{'fil<>l'ii{l.

blue (9.1 of california blueshieldca .com

Fresno City Employees Health and Welfare Trust Fiscal Year July `17 – June `18

P.O. BOX 45018

FRESNO, CA 93718-5018

(559) 499-2450

(800) 442-7247

FAX (559) 499-2464

Page 1

IMPORTANT ANNOUNCEMENT

April 29, 2017

TO: FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST ACTIVE PARTICIPANTS

RE: OPEN ENROLLMENT MAY 1 – JUNE 1

The annual open enrollment period will be from May 1 to June 1, 2017. During open enrollment you have the opportunity to change your dental/vision plan selection, your contribution election and verify or update any information we have about you or your dependents.

EVEN IF YOU ARE NOT MAKING ANY CHANGES, YOU MUST COMPLETE AND RETURN THE ENCLOSED FORMS TO

HEALTHCOMP BY JUNE 1, 2017. ANY CHANGES YOU MAKE WILL BE EFFECTIVE JULY 1, 2017.

You are required to complete and return the Open Enrollment Form and the Other Insurance Information

Questionnaire.

PLEASE NOTE: The Affordable Care Act requires Social Security numbers be provided for all plan

participants. To comply with this requirement, you must provide Social Security numbers for all plan

participants on the Open Enrollment Verification/Change Form.

The contribution election you made on your most recent Premium Conversion Plan/Payroll Deduction

Authorization Form will remain in effect for the 2017/2018 plan year and require no action on your part

unless you indicate on the enclosed Open Enrollment Form your desire to change your election.

The rate for medical, dental and vision benefits will increase with the new plan year beginning July 1, 2017. A contribution equal to 73% of the Trust rate of $1,200, or $871.00 (an increase of $12.00), will be made by the City on behalf of eligible employees defined under the MOU. The contribution from the City of Fresno into the Trust Fund is not enough to cover the full rate. In order to receive full benefits, active employees will be required to contribute by payroll deduction, the difference between the $1,200 Trust Fund rate and the City contribution. In order to receive full benefits, the employee’s 27% contribution will be $329.00 per month (an increase of $12.00).

IF YOU MAKE THE CONTRIBUTION OF $329.00, FOR MEDICAL AND MENTAL HEATH CARE SERVICES, A

DEDUCTIBLE OF $200 PER INDIVIDUAL AND $600 PER FAMILY WILL APPLY; AND AFTER MEETING THE

DEDUCTIBLE, A MEMBER CO-INSURANCE RESPONSIBILITY OF 20% FOR IN-NETWORK SERVICES WILL APPLY

UNTIL THE OUT-OF-POCKET IN-NETWORK LIMIT OF $3,200 PER INDIVIDUAL AND $6,400 PER FAMILY IS REACHED.

(A SEPARATE OUT-OF-POCKET LIMIT OF $3,400 PER INDIVIDUAL AND $6,800 PER FAMILY WILL APPLY FOR

PRESCRIPTION DRUG EXPENSES.)

IF YOU DO NOT MAKE THE CONTRIBUTION OF $329.00 AND THE TRUST FUND RECEIVES ONLY AN $871.00

CONTRIBUTION FROM THE CITY, FOR MEDICAL AND MENTAL HEALTH CARE SERVICES, A DEDUCTIBLE OF $1,300

PER INDIVIDUAL AND $2,600 PER FAMILY WILL APPLY; AND AFTER MEETING THE DEDUCTIBLE, A MEMBER CO-

INSURANCE RESPONSIBILITY OF 46% FOR IN-NETWORK SERVICES WILL APPLY UNTIL THE OUT-OF-POCKET IN-

NETWORK LIMIT OF $4,600 PER INDIVIDUAL AND $9,200 PER FAMILY IS REACHED. (SIMILAR REDUCTIONS WILL

APPLY FOR PRESCRIPTION DRUG EXPENSES INCLUDING A SEPARATE OUT-OF-POCKET LIMIT OF $2,000 PER

INDIVIDUAL AND $4,000 PER FAMILY.)

Page 2

If you do not elect to make the necessary Monthly Employee contribution, this may result in a substantial patient liability for medical and walk-in prescription drug services. In the following example, Employee A is paying his/her monthly employee contribution. Employee B elected to not make the payroll deduction. The following chart shows how their benefits would be calculated for a $5,000 in-network charge, assuming the respective deductibles have not previously been satisfied.

Employee A* Employee B**

City Contribution $871.00 $871.00

Employee Contribution $329.00 $ 0.00

Total Monthly Contribution $1,200.00 $871.00

In-Network Medical Charge $ 5,000 $ 5,000

Employee Deductible $ 200 $ 1,300

Employee Co-Insurance $ 960 $ 1,702

Employee Pays $ 1,160 $ 3,002

Plan Pays $ 3,840 $ 1,998

* After the first $200 was applied to the deductible, Employee A pays 20% of the next $4,800 in charges or $960 for a total employee payment of $1,160. **After the first $1,300 was applied to the deductible, Employee B pays 46% of the next $3,700 in charges or $1,702 for a total employee payment of $3,002.

A full description of your benefits may be found in the July 1, 2017 Fresno City Employees Health and Welfare Trust Plan Booklet, which will be posted on the Fresno City website when finalized. Up-to-date links to provider directories from Blue Shield, MES Vision, Pacific Union Dental, and Delta Dental will also be posted on the Fresno City website when made available: www.fresno.gov/Government/DepartmentDirectory/Personnel/EmployeeBenefits/default.htm.

Checklist for Open Enrollment Completion

Open Enrollment Verification/Change Form (REQUIRED)

Verify/Change Personal and Dependent Information Add Dependent Social Security Numbers Verify/Change Medical Plan Election Verify/Change Dental Plan Election Verify/Change Vision Plan Election Sign and Date

Other Insurance Information Questionnaire Form (REQUIRED)

A stamped self-addressed envelope has been enclosed for your convenience. If you have any questions regarding your open enrollment selection or would like to receive a printed version of the July 1, 2017 Plan Booklet, please contact HealthComp at (559) 499-2450.

The Board of Trustees

http://www.fresno.gov/Government/DepartmentDirectory/Personnel/EmployeeBenefits/default.htm

Fresno City Employees Health and Welfare Trust Fiscal Year July `17 – June `18

P.O. BOX 45018

FRESNO, CA 93718-5018

(559) 499-2450

(800) 442-7247

FAX (559) 499-2464

(Continued on Reverse)

IMPORTANT ANNOUNCEMENT

April 29, 2017

TO: RETIRED FRESNO CITY EMPLOYEES HEALTH & WELFARE TRUST

PARTICIPANTS

RE: OPEN ENROLLMENT MAY 1 – JUNE 1

The annual open enrollment period will be from May 1 to June 1, 2017. During open enrollment you have the opportunity to change your dental plan selection and/or verify or update any information we have about you or your dependents.

EVEN IF YOU ARE NOT MAKING ANY CHANGES, YOU MUST COMPLETE AND RETURN

THE ENCLOSED FORMS TO HEALTHCOMP BY JUNE 1, 2017. ANY CHANGES YOU

MAKE WILL BE EFFECTIVE JULY 1, 2017.

PLEASE NOTE: The Affordable Care Act requires Social Security numbers be provided

for all plan participants. To comply with this requirement, you must provide Social

Security numbers for all plan participants on the Open Enrollment Verification/Change

Form.

The monthly rates for Medical and Dental benefits will increase 2% for the new plan year beginning July 1, 2017:

Rate Retirees under 65: Health only $1,112 Dental only $ 88 Health and Dental $1,200

Over 65 (with Medicare): Health only (per individual) $ 618 Dental only (per family) $ 88 Health and Dental:

One Person $ 706 Two Person $1,324

Over 65 (without Medicare): Health only $1,341 Dental only $ 88

Health and Dental $1,429 When you enroll in the Optum Rx Medicare Prescription Drug Plan your monthly premium for your health benefits will be reduced by $50. You will receive a $50 reduction in your health premium beginning the first of the month following your approval from Medicare.

Page 2

A full description of your benefits may be found in the July 1, 2017 Fresno City Employees Health and Welfare Trust Plan Booklet, which will be posted on the Fresno City website when finalized. Up-to-date links to provider directories from Blue Shield, MES Vision, Pacific Union Dental, and Delta Dental will also be posted on the Fresno City website when made available: www.fresno.gov/Government/DepartmentDirectory/Personnel/EmployeeBenefits/default.htm

Checklist for Open Enrollment Completion

Complete Open Enrollment Verification/Change Form (REQUIRED)

Verify/Change Personal and Dependent Information

Add Dependent Social Security Number

Verify/Change Medical Plan Election

Verify/Change Dental Plan Election

Sign and Date

Complete Other Insurance Information Questionnaire Form (REQUIRED)

A stamped self-addressed envelope has been enclosed for your convenience.

If you have any questions regarding your open enrollment selection or would like to

receive a printed version of the July 1, 2017 Plan Booklet, please contact HealthComp at

(559) 499-2450.

The Board of Trustees


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Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2017 – 06/30/2018 City of Fresno: Employee Health and Welfare Trust Coverage for: Individual + Spouse + Children| Plan Type: High Plan

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, contact HealthComp at

www.healthcomp.com. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-800-442-7247 to request a copy.

Important Questions Answers Why This Matters:

What is the overall deductible?

$200/individual or $600/family

Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Are there services covered before you meet your deductible?

Yes. Preventive care services are covered before you meet your deductible.

This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.

Are there other deductibles for specific services?

No.

You don’t have to meet deductibles for specific services.

What is the out-of-pocket limit for this plan?

For network providers $3,200 individual / $6,400 family; for prescriptions $3,400 individual / $6,800 family

The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.

What is not included in the out-of-pocket limit?

Premiums, balance-billing charges, and health care this plan doesn’t cover and non-network charges.

Even though you pay these expenses, they don’t count toward the out–of–pocket limit.

Will you pay less if you use a network provider?

Yes. Refer to the Plan Document for information on how to locate a Network provider.

This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

Do you need a referral to see a specialist?

No. You can see the specialist you choose without referral.

https://www.healthcare.gov/sbc-glossary/#plan



https://www.healthcare.gov/sbc-glossary/#premium

https://www.healthcare.gov/sbc-glossary/#allowed-amount

https://www.healthcare.gov/sbc-glossary/#balance-billing

https://www.healthcare.gov/sbc-glossary/#coinsurance

https://www.healthcare.gov/sbc-glossary/#copayment

https://www.healthcare.gov/sbc-glossary/#deductible

https://www.healthcare.gov/sbc-glossary/#provider

https://www.healthcare.gov/sbc-glossary









https://www.healthcare.gov/sbc-glossary/#preventive-care








https://www.healthcare.gov/sbc-glossary/#cost-sharing




https://www.healthcare.gov/coverage/preventive-care-benefits/



https://www.healthcare.gov/sbc-glossary/#out-of-pocket-limit



https://www.healthcare.gov/sbc-glossary/#network-provider












https://www.healthcare.gov/sbc-glossary/#network



https://www.healthcare.gov/sbc-glossary/#out-of-network-provider








https://www.healthcare.gov/sbc-glossary/#referral

https://www.healthcare.gov/sbc-glossary/#specialist



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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.

Common

Medical Event Services You May Need

What You Will Pay Limitations, Exceptions, & Other Important

Information Network Provider

(You will pay the least) Out-of-Network Provider (You will pay the most)

If you visit a health care provider’s office or clinic

Primary care visit to treat an injury or illness

20% coinsurance 50% coinsurance None

Specialist visit 20% coinsurance 50% coinsurance None

Preventive care/screening/ immunization

No charge 50% coinsurance

You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for.

If you have a test

Diagnostic test (x-ray, blood work)

20% coinsurance 50% coinsurance Additional $25 copayment for services performed at a hospital-based lab.

Imaging (CT/PET scans, MRIs) 20% coinsurance 50% coinsurance

If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.[insert].com

Generic drugs (Tier 1)

10% coinsurance/ prescription (retail) $5 copay/prescription (mail order)

Not covered

Covers up to a 34-day supply (retail prescription); 90 day supply (mail order prescription).

Preferred brand drugs (Tier 2)


Not covered

Non-preferred brand drugs (Tier 3)


Not covered

Specialty drugs (Tier 4) $100 copay/prescription (retail or mail order)

Not covered

If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center)

$250/copay/surgery & 20% coinsurance


Copay does not apply to free-standing ambulatory surgery center. Precertification is required. If you don't get precertification, benefits could be reduced.

Physician/surgeon fees 20% coinsurance 50% coinsurance None












https://www.healthcare.gov/sbc-glossary/#screening





https://www.healthcare.gov/sbc-glossary/#diagnostic-test





https://www.healthcare.gov/sbc-glossary/#prescription-drug-coverage








https://www.healthcare.gov/sbc-glossary/#specialty-drug







https://www.healthcare.gov/sbc-glossary/#preauthorization



3 of 6

Common

Medical Event Services You May Need What You Will Pay

Limitations, Exceptions, & Other Important

Information

If you need immediate medical attention

Emergency room care $200/copay visit & 20% coinsurance

$200/copay visit & 20% coinsurance

None Emergency medical transportation

20% coinsurance 20% coinsurance

Urgent care 20% coinsurance 50% coinsurance

If you have a hospital stay

Facility fee (e.g., hospital room) $250/ copay/admission & 20% coinsurance

$250/ copay/admission & 50% coinsurance

Precertification is required. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.


If you need mental health, behavioral health, or substance abuse services

Outpatient services

20% coinsurance/office visit and 20% coinsurance for other outpatient services

50% coinsurance Precertification is required for inpatient services. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.

Inpatient services $250/ copay/admission & 20% coinsurance


If you are pregnant

Office visits 20% coinsurance 50% coinsurance Cost sharing does not apply to certain preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).

Childbirth/delivery professional services


Childbirth/delivery facility services



If you need help recovering or have other special health needs

Home health care 20% coinsurance 50% coinsurance Precertification is required. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.

Rehabilitation services 20% coinsurance 50% coinsurance Includes physical therapy, speech therapy, and occupational therapy. Habilitation services must be authorized by Psy-Care.

Habilitation services 20% coinsurance 50% coinsurance

Skilled nursing care $250/ copay/admission & 20% coinsurance



Durable medical equipment 20% coinsurance 50% coinsurance Precertification is required if over $1,000. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.

https://www.healthcare.gov/sbc-glossary/#emergency-room-care-emergency-services





https://www.healthcare.gov/sbc-glossary/#emergency-medical-transportation




https://www.healthcare.gov/sbc-glossary/#urgent-care































https://www.healthcare.gov/sbc-glossary/#home-health-care





https://www.healthcare.gov/sbc-glossary/#rehabilitation-services



https://www.healthcare.gov/sbc-glossary/#habilitation-services



https://www.healthcare.gov/sbc-glossary/#skilled-nursing-care







https://www.healthcare.gov/sbc-glossary/#durable-medical-equipment





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Common



Information

Hospice services 20% coinsurance 50% coinsurance Precertification is required. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.

If your child needs dental or eye care

Children’s eye exam

See www.fresno.gov/Government/DepartmentDirectory/Personnel/EmployeeBenefits/default.htm Children’s glasses

Children’s dental check-up

https://www.healthcare.gov/sbc-glossary/#hospice-services






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Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Cosmetic Surgery

Infertility Treatment (except services to diagnose infertility)

Long Term Care

Non-emergency care when traveling outside the U.S.

Private Duty Nursing

Routine Foot Care

Weight Loss Programs

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

Acupuncture (if medically necessary)

Bariatric Surgery

Chiropractic Care

Dental care (Adult)

Hearing Aids

Routine eye care (Adult)

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: Department of Health and Human Services, Center for Consumer Information and Insurance Oversight, at 1-877-267-2323 x61565 or www.cciio.cms.gov. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact: HealthComp Administrators at 1-800-442-7247. Does this plan provide Minimum Essential Coverage? Yes. If you don’t have Minimum Essential Coverage for a month, you’ll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month. Does this plan meet Minimum Value Standards? Yes. If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace. Language Access Services: Spanish (Español): Para obtener asistencia en Español, llame al 1-800-442-7247. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-442-7247.

Chinese (中文): 如果需要中文的帮助，请拨打这个号码1-800-442-7247.

Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-442-7247. ––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next section.––––––––––––––––––––––



https://www.healthcare.gov/sbc-glossary/#excluded-services


http://www.cciio.cms.gov/

https://www.healthcare.gov/sbc-glossary/#marketplace


http://www.healthcare.gov/


https://www.healthcare.gov/sbc-glossary/#claim

https://www.healthcare.gov/sbc-glossary/#grievance

https://www.healthcare.gov/sbc-glossary/#appeal







https://www.healthcare.gov/sbc-glossary/#minimum-essential-coverage


https://www.healthcare.gov/sbc-glossary/#minimum-value-standard

https://www.healthcare.gov/sbc-glossary/#premium-tax-credits



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The plan would be responsible for the other costs of these EXAMPLE covered services.

Peg is Having a Baby

(9 months of in-network pre-natal care and a hospital delivery)

Mia’s Simple Fracture

(in-network emergency room visit and follow up care)

Managing Joe’s type 2 Diabetes

(a year of routine in-network care of a well-controlled condition)

The plan’s overall deductible $200 Specialist copayment $0 Hospital (facility) coinsurance 20% Other coinsurance 20% This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia)

Total Example Cost $12,800

In this example, Peg would pay:

Cost Sharing

Deductibles $200

Copayments $250

Coinsurance $2,458

What isn’t covered

Limits or exclusions $60

The total Peg would pay is $2,968

The plan’s overall deductible $200 Specialist copayment $0 Hospital (facility) coinsurance 20% Other coinsurance 20% This EXAMPLE event includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)


In this example, Joe would pay:

Cost Sharing

Deductibles $200

Copayments $0

Coinsurance $938



The total Joe would pay is $1,198

The plan’s overall deductible $200 Specialist copayment $0 Hospital (facility) coinsurance 20% Other coinsurance 20% This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray) Durable medical equipment (crutches) Rehabilitation services (physical therapy)


In this example, Mia would pay:

Cost Sharing

Deductibles $200

Copayments $200

Coinsurance $300



The total Mia would pay is $700

About these Coverage Examples:

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.

Note: These numbers assume the patient does not participate in the plan’s wellness program. If you participate in the plan’s wellness program, you may be able to

reduce your costs. For more information about the wellness program, please contact the Human Resources Department.






























1 of 6

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2017 – 06/30/2018 City of Fresno: Employee Health and Welfare Trust Coverage for: Individual + Spouse + Children| Plan Type: Low Plan

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, contact HealthComp at

www.healthcomp.com. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-800-442-7247 to request a copy.



$1,300/individual or $2,600/family

(if dual coverage applies: $200/individual or $600/family – examples not provided)






No.













































































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Common












If you have a test







Not covered




Not covered



Not covered


Not covered














































3 of 6

Common



Information













Outpatient services

40% coinsurance/office visit and 40% coinsurance for other outpatient services

62% coinsurance Precertification is required for inpatient services. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.



If you are pregnant














































































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Common



Information












5 of 6



Cosmetic Surgery


Long Term Care



Routine Foot Care




Bariatric Surgery

Chiropractic Care

Dental care (Adult)

Hearing Aids





























6 of 6











Cost Sharing

Deductibles $1,300

Copayments $250

Coinsurance $4,476







Cost Sharing

Deductibles $1,300

Copayments $0

Coinsurance $2,024







Cost Sharing

Deductibles $1,300

Copayments $200

Coinsurance $160



The total Mia would pay is $1,660


































1 of 6

Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 07/01/2017 – 06/30/2018 City of Fresno: Employee Health and Welfare Trust Coverage for: Individual + Spouse + Children| Plan Type: Low 32 Plan

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, www.healthcomp.com. For general

definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-800-442-7247 to request a copy.



$1,300/individual or $2,600/family

(if dual coverage applies: $200/individual or $600/family – examples not provided)






No.













































































2 of 6


Common












If you have a test







Not covered




Not covered



Not covered


Not covered














































3 of 6

Common



Information













Outpatient services 46% coinsurance 66% coinsurance Precertification is required for inpatient services. If you don't get precertification, benefits could be reduced by 50% of the total cost of the service.



If you are pregnant













































































4 of 6

Common



Information












5 of 6



Cosmetic Surgery


Long Term Care



Routine Foot Care




Bariatric Surgery

Chiropractic Care

Dental care (Adult)

Hearing Aids





























6 of 6











Cost Sharing

Deductibles $1,300

Copayments $250

Coinsurance $3,050







Cost Sharing

Deductibles $1,300

Copayments $0

Coinsurance $2,356







Cost Sharing

Deductibles $1,300

Copayments $200

Coinsurance $156



The total Mia would pay is $1,656


































CONFIDENTIAL

Report View of RXT1020DM - Executive Summary by Time PeriodDate Submitted From February 2016 Through January 2017

Client: City of Fresno

Measures February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 September 2016 October 2016MembershipAvg Eligible Members 9,430 9,359 9,338 9,356 9,412 9,442 9,426 9,479 9,429

Total Utilizing Members 2,713 2,731 2,623 2,601 2,571 2,473 2,627 2,603 2,644

% Utilizing Members 28.8% 29.2% 28.1% 27.8% 27.3% 26.2% 27.9% 27.5% 28.0%

Avg Member Age 32.88 32.96 33.01 33.02 32.99 32.96 32.95 32.88 32.92

Rx and CostTotal Rxs 6,687 6,901 6,342 6,399 6,328 5,953 6,531 6,243 6,609

Total Drug Cost $1,091,714.68 $1,188,677.54 $1,126,259.49 $1,240,615.20 $1,169,863.28 $1,117,496.01 $1,134,397.34 $1,189,666.83 $1,132,015.06

Total Plan Paid $981,251.00 $1,059,538.20 $1,015,806.93 $1,131,313.93 $1,052,487.55 $983,758.75 $1,011,606.40 $1,073,927.45 $1,012,787.13

Total Member Paid $110,463.68 $129,139.34 $110,452.56 $109,301.27 $117,375.73 $133,737.26 $122,790.94 $115,739.38 $119,227.93

Total Ingredient Cost $1,082,443.40 $1,179,181.14 $1,117,448.99 $1,231,718.02 $1,161,044.43 $1,109,252.77 $1,125,038.87 $1,180,082.54 $1,120,974.60

Total Dispensing Fee $9,271.28 $9,496.40 $8,810.45 $8,897.18 $8,818.85 $8,240.86 $9,138.70 $8,677.57 $9,055.17

Total Sales Tax $0.00 $0.00 $0.05 $0.00 $0.00 $2.38 $6.57 $5.12 $3.29

% Plan Paid 89.9% 89.1% 90.2% 91.2% 90.0% 88.0% 89.2% 90.3% 89.5%

% Member Paid 10.1% 10.9% 9.8% 8.8% 10.0% 12.0% 10.8% 9.7% 10.5%

Avg Drug Cost / Rx $163.26 $172.25 $177.59 $193.88 $184.87 $187.72 $173.69 $190.56 $171.28

Avg Plan Paid / Rx $146.74 $153.53 $160.17 $176.80 $166.32 $165.25 $154.89 $172.02 $153.24

Avg Member Paid / Rx $16.52 $18.71 $17.42 $17.08 $18.55 $22.47 $18.80 $18.54 $18.04

Per Member Per MonthAvg Rxs PMPM 0.71 0.74 0.68 0.68 0.67 0.63 0.69 0.66 0.70

Avg Drug Cost PMPM $115.77 $127.01 $120.61 $132.60 $124.29 $118.35 $120.35 $125.51 $120.06

Avg Plan Paid PMPM $104.06 $113.21 $108.78 $120.92 $111.82 $104.19 $107.32 $113.30 $107.41

Avg Member Paid PMPM $11.71 $13.80 $11.83 $11.68 $12.47 $14.16 $13.03 $12.21 $12.64

Drug Type% Single-Source Brand Rxs 17.7% 18.8% 18.0% 16.8% 16.4% 16.1% 17.1% 16.4% 18.6%

% Multi-Source Brand Rxs 1.2% 1.4% 1.5% 1.7% 1.7% 1.7% 1.4% 1.4% 1.2%

% Generic Rxs 81.0% 79.8% 80.4% 81.5% 82.0% 82.2% 81.5% 82.1% 80.2%

% Generic Efficiency 98.5% 98.3% 98.1% 97.9% 98.0% 98.0% 98.3% 98.3% 98.6%

Page 1

Measures February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 September 2016 October 2016Drug Channel% Retail Rxs 81.1% 80.5% 80.6% 80.4% 79.8% 79.9% 79.6% 80.3% 81.0%

% Retail 90 Rxs 11.2% 11.3% 12.0% 12.0% 12.8% 12.7% 12.6% 12.3% 11.7%

% Mail Rxs 7.7% 8.1% 7.4% 7.6% 7.4% 7.4% 7.8% 7.3% 7.3% Specialty Drugs

Total Specialty Rxs 59 62 64 69 57 53 58 73 70

Total Specialty Drug Cost $294,134.43 $280,520.03 $332,272.76 $404,573.67 $318,142.38 $292,040.09 $249,576.02 $395,634.60 $268,905.32

Total Specialty Plan Paid $288,388.50 $267,150.46 $322,311.39 $395,540.44 $311,555.72 $265,142.05 $238,142.34 $384,767.02 $260,218.20

Total Specialty Member Paid $5,745.93 $13,369.57 $9,961.37 $9,033.23 $6,586.66 $26,898.04 $11,433.68 $10,867.58 $8,687.12

% Specialty Rxs 0.9% 0.9% 1.0% 1.1% 0.9% 0.9% 0.9% 1.2% 1.1%

% Specialty of Total Drug Cost 26.9% 23.6% 29.5% 32.6% 27.2% 26.1% 22.0% 33.3% 23.8%

% Specialty of Total Plan Paid 29.4% 25.2% 31.7% 35.0% 29.6% 27.0% 23.5% 35.8% 25.7%

% Specialty of Total Member Paid 5.2% 10.4% 9.0% 8.3% 5.6% 20.1% 9.3% 9.4% 7.3%

Avg Specialty Rxs PMPM 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01

Avg Specialty Drug Cost PMPM $31.19 $29.97 $35.58 $43.24 $33.80 $30.93 $26.48 $41.74 $28.52

Avg Specialty Plan Paid PMPM $30.58 $28.54 $34.52 $42.28 $33.10 $28.08 $25.26 $40.59 $27.60

Avg Specialty Member Paid PMPM $0.61 $1.43 $1.07 $0.97 $0.70 $2.85 $1.21 $1.15 $0.92

Avg Non-Specialty Rxs PMPM 0.70 0.73 0.67 0.68 0.67 0.62 0.69 0.65 0.69

Avg Non-Specialty Drug Cost PMPM $84.58 $97.04 $85.03 $89.36 $90.49 $87.42 $93.87 $83.77 $91.54

Avg Non-Specialty Plan Paid PMPM $73.47 $84.67 $74.27 $78.64 $78.72 $76.11 $82.06 $72.70 $79.81

Avg Non-Specialty Member Paid PMPM $11.10 $12.37 $10.76 $10.72 $11.77 $11.32 $11.81 $11.06 $11.72

Page 2

Measures November 2016 December 2016 January 2017 Rolling TotalMembershipAvg Eligible Members 9,515 9,531 9,575 9,441Total Utilizing Members 2,575 2,691 2,776 2,636% Utilizing Members 27.1% 28.2% 29.0% 27.9%Avg Member Age 32.87 32.80 32.84 32.92Rx and CostTotal Rxs 6,247 6,745 7,025 78,010Total Drug Cost $1,037,741.00 $1,173,854.61 $1,335,793.89 $13,938,094.93Total Plan Paid $927,774.01 $1,060,445.27 $1,208,826.14 $12,519,522.76Total Member Paid $109,966.99 $113,409.34 $126,967.75 $1,418,572.17Total Ingredient Cost $1,028,377.60 $1,164,110.07 $1,325,739.98 $13,825,412.41Total Dispensing Fee $8,693.80 $9,374.94 $9,747.68 $108,222.88Total Sales Tax $0.00 $0.00 $0.43 $17.84% Plan Paid 89.4% 90.3% 90.5% 89.8%% Member Paid 10.6% 9.7% 9.5% 10.2%Avg Drug Cost / Rx $166.12 $174.03 $190.15 $178.67Avg Plan Paid / Rx $148.52 $157.22 $172.07 $160.49Avg Member Paid / Rx $17.60 $16.81 $18.07 $18.18Per Member Per MonthAvg Rxs PMPM 0.66 0.71 0.73 0.69Avg Drug Cost PMPM $109.06 $123.16 $139.51 $123.03Avg Plan Paid PMPM $97.51 $111.26 $126.25 $110.51Avg Member Paid PMPM $11.56 $11.90 $13.26 $12.52Drug Type% Single-Source Brand Rxs 16.6% 15.4% 16.2% 17.0%% Multi-Source Brand Rxs 1.6% 1.4% 1.4% 1.5%% Generic Rxs 81.8% 83.3% 82.4% 81.5%% Generic Efficiency 98.0% 98.4% 98.4% 98.2%Drug Channel% Retail Rxs 80.8% 80.7% 81.3% 80.5%% Retail 90 Rxs 12.4% 12.4% 11.5% 12.1%

% Mail Rxs 6.8% 6.9% 7.2% 7.4%

Page 3

Measures November 2016 December 2016 January 2017 Rolling Total Specialty DrugsTotal Specialty Rxs 58 59 67 749Total Specialty Drug Cost $245,199.26 $300,100.81 $373,616.47 $3,754,715.84Total Specialty Plan Paid $238,971.43 $293,742.48 $362,805.75 $3,628,735.78Total Specialty Member Paid $6,227.83 $6,358.33 $10,810.72 $125,980.06% Specialty Rxs 0.9% 0.9% 1.0% 1.0%% Specialty of Total Drug Cost 23.6% 25.6% 28.0% 26.9%% Specialty of Total Plan Paid 25.8% 27.7% 30.0% 29.0%% Specialty of Total Member Paid 5.7% 5.6% 8.5% 8.9%Avg Specialty Rxs PMPM 0.01 0.01 0.01 0.01Avg Specialty Drug Cost PMPM $25.77 $31.49 $39.02 $33.14Avg Specialty Plan Paid PMPM $25.12 $30.82 $37.89 $32.03Avg Specialty Member Paid PMPM $0.65 $0.67 $1.13 $1.11Avg Non-Specialty Rxs PMPM 0.65 0.70 0.73 0.68Avg Non-Specialty Drug Cost PMPM $83.29 $91.67 $100.49 $89.89Avg Non-Specialty Plan Paid PMPM $72.39 $80.44 $88.36 $78.48Avg Non-Specialty Member Paid PMPM $10.90 $11.23 $12.13 $11.41

Page 4

Column Name

Carrier ID

Group IDAvg Eligible MembersTotal Utilizing Members% Utilizing MembersAvg Member AgeTotal RxsTotal Drug Cost

Total Plan Paid

Total Member PaidTotal Ingredient CostTotal Dispensing FeeTotal Sales Tax% Plan Paid% Member PaidAvg Drug Cost / RxAvg Plan Paid / RxAvg Member Paid / RxAvg Rxs PMPMAvg Drug Cost PMPMAvg Plan Paid PMPMAvg Member Paid PMPM% Single-Source Brand Rxs% Multi-Source Brand Rxs% Generic Rxs% Generic Efficiency% Retail Rxs% Retail 90 Rxs% Mail RxsTotal Specialty Rxs

Description

RxCLAIM® Carrier ID, alphanumeric. Part of basic four-tiered system (Carrier>Account>Group>Mbr) allowing for flexibility in defining benefit parameters for a group of people. Carriers are the highest level of the hierarchy used in RxCLAIM. A carrier is typically the company or organization who offers benefits to Mbrs.

Part of a four-tiered system (Carrier>Account>Group>Member) allowing for flexibility in defining benefit parameters for a group of people. Groups are the third level of the hierarchy used in RxCLAIM. They belong to the account. Carriers use groups to further divide accounts, so that specific benefits can be assigned to each group.The eligible claim count defined in RxTRACK by counting actual days in a month that a member was eligible.A distinct count of members that have at least one paid claim within the specified time frame.The percentage of the total utilizing members.

Average member age during the reporting period calculated using a combination of the client's eligibility age bands and member counts.The total number of rxs.The total drug cost.

"Commercial:The Client Total Amount Due. Typically, amount due is calculated as follows: (Ingredient Cost + Dispensing Fee + Tax) – Patient Pay.Medicare

Part D:The Client Total Amount Due. For Medicare Part D claims specifically, amount due is calculated as follows: (Ingredient Cost + Dispensing Fee + Tax + Incentive Fee) – Patient Pay. This calculation does not include LICS amount. However check your benefit setup as there is a flag that controls this value in

RxCLAIM."

"Commercial:The Client Total Patient Pay Amount. The patient pay would include copays and all other charges paid by the member.Medicare Part D:The Client Total Patient Pay Amount. For Medicare Part D claims specifically, the patient pay would include copays and all other charges paid by the member and does also include LICS amount."The Client Ingredient Cost.The Client Dispensing Fee.The Client Sales Tax.The percentage the plan paid of the total drug cost.The percentage the member paid of the total drug cost.The average drug cost per rx.The average plan cost per rx.The average member cost per rx.The average number of rxs per member per month.The average drug cost per member per month.The average plan cost per member per month.The average member cost per member per month.The percentage of rxs filled with a single-source brand drug.The percentage of rxs filled with a multi-source brand drug.The percentage of rxs filled with a generic drug.The percentage of the use of a generic rx where one could potentially be used.The percentage of rxs filled at a retail pharmacy.The percentage of rxs filled at a retail pharmacy where days supply meets "Retail 90" rules.The percentage of rxs filled at a mail order pharmacy.The total number of specialty drug rxs.

Page 5

Total Specialty Drug CostTotal Specialty Plan PaidTotal Specialty Member Paid% Specialty Rxs% Specialty of Total Drug Cost% Specialty of Total Plan Paid% Specialty of Total Member PaidAvg Specialty Rxs PMPMAvg Specialty Drug Cost PMPMAvg Specialty Plan Paid PMPMAvg Specialty Member Paid PMPMAvg Non-Specialty Rxs PMPMAvg Non-Specialty Drug Cost PMPMAvg Non-Specialty Plan Paid PMPMAvg Non-Specialty Member Paid PMPM

The total drug cost of specialty drug rxs.The total plan cost of specialty drug rxs.The total member cost of specialty drug rxs.The percentage of rxs filled with a specialty drug.The percentage specialty of the total drug cost.The percentage specialty of the total plan paid.The percentage specialty of the total member paid.The average number of specialty rxs per member per month.The average specialty drug cost per member per month.

The average non-specialty member cost per member per month.

The average specialty plan cost per member per month.The average specialty member cost per member per month.The average number of non-specialty rxs per member per month.The average non-specialty drug cost per member per month.The average non-specialty plan cost per member per month.

Page 6

Fresno City Employees Health & Welfare Trust PA Detail Report Summary

Time Frame: 01.01.17-01.31.17

Row Labels Count of Case Number

APPROVED 28

APPEAL 1

NEW 27

DENIED 5

NEW 5

Grand Total 33

Case Number Auth Type Description Decision Request Type Description Drug Product Description

Request

Date

Decision

Date

Days to Decision Date

(TAT 15 days - Standard

Request)

17006052071 NEW APPROVED STEP THERAPY PRILOSEC POW 10MG 01/06/17 01/06/17 0

17007380824 NEW APPROVED PRIOR AUTHORIZATION REPATHA SURE INJ 140MG/ML 01/06/17 01/09/17 3

17006324711 NEW APPROVED PRIOR AUTHORIZATION STELARA INJ 90MG/ML 01/06/17 01/09/17 3

17010231068 NEW APPROVED PRIOR AUTHORIZATION HUMIRA PEN INJ PSORIASI 01/09/17 01/10/17 1

17011352210 NEW APPROVED PRIOR AUTHORIZATION H.P. ACTHAR INJ 80UNIT 01/11/17 01/11/17 0

17010292011 NEW APPROVED STEP THERAPY DESVENLAFAX TAB 100MG ER 01/10/17 01/11/17 1

17011305073 NEW APPROVED STEP THERAPY DYMISTA SPR 137-50 01/11/17 01/12/17 1

17011232385 NEW APPROVED PRIOR AUTHORIZATION USTEKINUMAB SOLN PREFILLED SYR 01/11/17 01/12/17 1

17013002520 NEW APPROVED PRIOR AUTHORIZATION MODAFINIL TAB 200MG 01/13/17 01/13/17 0

17017030225 NEW APPROVED PRIOR AUTHORIZATION ENSTILAR AER 01/17/17 01/17/17 0

17017084484 NEW APPROVED PRIOR AUTHORIZATION TECFIDERA CAP 240MG 01/17/17 01/17/17 0

17017292872 APPEAL APPROVED PRIOR AUTHORIZATION NUVIGIL TAB 50MG 01/17/17 01/18/17 1

17018197221 NEW APPROVED PRIOR AUTHORIZATION MAKENA INJ 250MG/ML 01/17/17 01/18/17 1

17018264675 NEW APPROVED PRIOR AUTHORIZATION BELVIQ TAB 10MG 01/18/17 01/19/17 1

17018132923 NEW DENIED PRIOR AUTHORIZATION AMPHET/DEXTR TAB 30MG 01/18/17 01/19/17 1

17018367161 NEW APPROVED PRIOR AUTHORIZATION QSYMIA CAP 3.75-23 01/18/17 01/19/17 1

17018171864 NEW DENIED PRIOR AUTHORIZATION ARMODAFINIL TAB 150MG 01/18/17 01/20/17 2

17020388381 NEW APPROVED PRIOR AUTHORIZATION ADDERALL XR CAP 30MG 01/19/17 01/20/17 1

17020171795 NEW APPROVED STEP THERAPY EDARBI TAB 80MG 01/19/17 01/22/17 3

17020288803 NEW APPROVED PRIOR AUTHORIZATION VYVANSE CAP 20MG 01/20/17 01/23/17 3

17020290275 NEW APPROVED PRIOR AUTHORIZATION AMPHET/DEXTR CAP 10MG ER 01/20/17 01/23/17 3

Page 1

17024016783 NEW APPROVED PRIOR AUTHORIZATION MODAFINIL TAB 200MG 01/24/17 01/24/17 0

17024072056 NEW APPROVED PRIOR AUTHORIZATION HUMIRA PEN INJ CROHNS 01/24/17 01/25/17 1

17024263117 NEW DENIED PRIOR AUTHORIZATION MODAFINIL TAB 200MG 01/24/17 01/25/17 1

17025310530 NEW APPROVED PRIOR AUTHORIZATION LONSURF TAB 15-6.14 01/25/17 01/26/17 1

17025231404 NEW APPROVED PRIOR AUTHORIZATION PHENTERMINE CAP 37.5MG 01/25/17 01/26/17 1

17026323105 NEW APPROVED PRIOR AUTHORIZATION PHENTERMINE TAB 37.5MG 01/25/17 01/26/17 1

17026192097 NEW APPROVED PRIOR AUTHORIZATION ACTEMRA INJ 162/0.9 01/26/17 01/27/17 1

17026339699 NEW DENIED REIMBURSEMENT CHANGE POLYETH GLYC POW 3350 NF 01/26/17 01/28/17 2

17027343882 NEW DENIED PRIOR AUTHORIZATION OTEZLA TAB 30MG 01/27/17 01/28/17 1

17027242595 NEW APPROVED PRIOR AUTHORIZATION TRETINOIN CRE 0.05% 01/27/17 01/28/17 1

17026262353 NEW APPROVED STEP THERAPY VIIBRYD TAB 10MG 01/25/17 01/29/17 4

17030331434 NEW APPROVED PRIOR AUTHORIZATION BUTRANS DIS 5MCG/HR 01/30/17 01/30/17 0

Page 2

For: FRESNO City Employees H&W Trust

Re: PBM Consulting Services

Highlights for Trustees

In business since 1991

Exclusively pharmacy benefit consulting (PBM Consulting, PBM Auditing, Specialty Drug Management, Medicare Part D Solutions)

Proprietary software and analytics

Industry experts in this field

Independent from PBMs

Extensive experience with public sector and jointly trusteed H&W plans

In-depth knowledge of PBM procedures, operations, claims data processing and reporting

Best-practice standards for claims data analysis and HIPPA security

Company Profile

Confidential Information- Not To Be Redistributed

About The Virtuous Group

• The Virtuous Group, Nevada based, provides multi-level pharmacy benefit related consultation and definitive, measured clinical outcomes.

• The Virtuous Group staff is made up of senior level clinical pharmacists, CPA’s, and actuarial report writers/analysts.

• Pharmacy benefit data in itself has many elements that when looked at from multiple directions can indeed yield information that is critical for the client. The problem is that many auditors and many consultants don’t have the internal ability or PBM experience to accomplish this without “making assumptions” or frankly using their “best guess”. This brings the “human error” component into the equation.

• The Virtuous Group system is an electronic, proprietary system that allows the user to “upload” raw client data. The system will then yield a multiple array of results based on the criteria needed. Before the results are displayed, the system actually tests the results from different perspectives to verify the accuracy of the results.

2


About The Virtuous Group

• Today the Virtuous Group assists health plans, employer groups, trusts, and consultants with all aspects of the pharmacy benefit program. This includes, but is not limited to:

▫ Complete RFP Services

Straight to the point approach

Typical turn-around, 45 days RFP to Contract

▫ PBM Audit Programs Direct approach

Double blind staff internal program to eliminate errors

Entire report less than 12 pages

Complete Audit to Collections methodology

All of this helps keep the audit cost dollars down

▫ Formulary Adherence Reviews

▫ Benefit Plan Review, Assumption data

What if scenarios

Client, Consultant, or frankly our recommendations

▫ Ongoing Clinical oversight and PBM interaction Day to day activity

Account manager support

Implementation services

Basic PBM support. Right arm of the client

3


Service Area Breakdown

RFP Support,

25%

PBM Audit, 30%

Ongoing Clinical

Support, 45%

4


Pharmacy Benefit Management

Auditing (What’s The Hot Topic)

FACTS

• Transparency vs Traditional PBM Approaches

• 95% of every medium to large PBM makes their profit…..NOT on the PBM RFP, but rather the last days of the contract experience.

• In other words, the PBM’s initial responses are based on nothing more than their experience with each consultant and what they think that consultant will miss or better yet what he/she will concentrate on more.

• The other big issue out there right now is the word Transparency. Most PBM’s that are in a relationship whereas they cannot take “spread”, will actually do it anyway by forcing claims thru a more favorable contract they have with their pharmacy network. The pharmacy networks know it is happening , but cannot match contracts with group level data and therefore the PBM’s can get away with it. Audits won’t work because the PBM’s simply show the auditor the contracts that match the pricing. Not the contracts the claims are being run through.

• We have developed both an RFP strategy and contracting strategy that makes the

entire process short and client centric. An RFP does not need to cost a ton of money with the system we have developed.

• Furthermore, the subsequent Audits are also less expensive, simply, because of the up front work on the RFP/Contracting. We will know in 3 weeks after a PBM begins work on a client, whether or not the terms are being met.

• With all of this work behind us, we simply can concentrate on the clients true clinical picture and get involved more deeply in utilization control, special programs that a PBM does not offer, etc.

• For Example: ▫ PBM performance programs management and result analysis ▫ Real-time Diabetes control mechanisms and coaching ▫ Network Building protocols True Choice America TM

•

5


Client Breakdown

Taft Hartley 46%

Self-Funded Employers

27%

Health Plan 9%

Consultant Backroom

18%

6


A Few Clients

• HEREIU (Culinary Health Fund)

• Operating Engineers Local 12

• Nevada Healthcare Coalition

• Cement Masons Southern California

• City of Reno

• Washoe County

• Clark County School District

• Kern County

• MGM Resorts Properties

• American Casino Properties

• Various Taft Hartley

7


Principals

• Kevin Hooks, R.Ph., Managing Partner

▫ Kevin was the Sole Founder and President of Catalyst Rx, which is currently the 3rd largest public PBM in the industry. Kevin left in 2009 where he served as President of the Employer and Union Divisions. In addition to having over 20 years in the industry, Kevin also has over 10 years in retail pharmacy management, clinical hospital pharmacy practice, home infusion and the specialty pharmacy industry. Kevin has a pharmacy degree and residency program from The University of Toledo and University of Florida.

• Darren Sivertsen, CPA, Managing Partner ▫ Darren Sivertsen has over 20 years experience in the accounting and

healthcare arenas . Darren served as a manager in the KPMG health care practice division which mainly involved auditing of health plans and hospitals. Darren most recent position was Senior Vice President and Chief Operating Officer for Sierra Health Services. Darren was also responsible for all internal audit functions, pharmacy benefit management and associated Medicare Part D operations. In addition to Darren also holds a Masters in business administration from the University of Utah.

8


Tentative Scope and Costs AUDIT (Contract Adherence)

• Financial review of all claims for 2015 and 2016. (Retail, Mail, Specialty)

• Review of all Performance Guarantees

• Review of all prior authorization and step therapy processes for compliance.

• Formulary compliance.

• Review of administration of correct copays per plan documentation.

• Complete review of contractual guarantees related to Manufacturer Rebate programs.

• Fraud/Waste and Abuse report.

• Provide concise reporting to group on findings.

COST BY ITSELF $19,500

PBM RFP

• Provide a complete RFP/PBM questionnaire. This RFP is not overly extensive. Questions included are valid, critical, and customized for this plan and the selection of a PBM that provides the best match for this group.

• Creation of interactive database based on each PBM’s response. This allows what if scenarios that a consultant or plan manager may ask for during the course of final selection.

• Provide final report in person to the group, with condensed financial stats on each PBM and comments and recommendations.

• Additionally we will provide a financial comparison that will provide unique access/look into direct retail pharmacy network possibilities and direct to pharma rebates. Each PBM responding will provide an answer to their capacity/willingness to support such a relationship within the scope of the RFP.

COST BY ITSELF $12,000

COMBINED $26,500*

*When completing an audit, we will have created a financial database of each and every claim. That same database would be used for repricing each claim and evaluating every PBM response and will save the costs of creating it twice. Those savings are passed on.

9

Title goes here

xxx

xx

FRESNO City Employees Health & Welfare Trust

March 8, 2017

Pharmacy Benefit Management Consulting Services

Prepared for: Fresno City Employees H&W Trust 1

TABLE OF CONTENTS

Section Description Page I Table of Contents 1 II Cover Letter 2

III Executive Summary 3 IV Why WBC/TRICAST 4 V Services Description 7 VI HIPAA Security 11

VII Exhibit A - Fees 13 VIII Exhibit B – Key Staffing 14 IX Exhibit C - References 17 X Exhibit D – Certificate of Insurance 18



March 1, 2017

Mr. Jim Rhein Rael & Letson 2800 Campus Drive, Suite 150 San Mateo, CA 94403 Re: PBM Audit and Consulting Services Overview for Fresno City Employees H&W Trust Dear Mr. Rhein: Thank you for the opportunity to be considered for the services described in this overview proposal. We would welcome the chance to support the Fresno City Employees Health & Welfare Trust and hope you find our proposal compelling. The services and estimated fees described in this overview proposal are valid for 90 days from the date of this letter. Cordially,

__________________________________ Roy Wilkinson President & CEO Wilkinson Benefit Consultants, Inc. 1812 W. Burbank Blvd., Suite #143 Burbank, CA 91506 410-905-1463 (Direct) [email protected]

mailto:[email protected]



III. Executive Summary Wilkinson Benefit Consultants, Inc. (“WBC”) is a national pharmacy benefit consulting firm founded in 1991. We focus exclusively on assisting plan sponsors manage their pharmacy benefit. Founded by Roy Wilkinson, we are a firm of 12 consultants, which includes former PBM executives, actuarial consulting firm officers, an M.D., several Doctors of Pharmacy, a PhD in pharmacoeconomics, and a former PBM attorney. We offer PBM consulting (RFP creation, procurement, contracting, negotiations, clinical analysis), PBM auditing, Specialty Drug management and Medicare Part D solutions. We have created a joint venture for auditing PBMs with TRICAST, a 40-employee Milwaukee-based leading provider of pharmacy benefit management technology solutions. WBC/TRICAST has worked together for 8 years and leverages nearly 20 years of TRICAST’s technology and claims processing expertise, extensive client insight and a team of industry experts to offer forward-thinking, full-scope pharmacy benefit auditing and oversight. WBC/TRICAST recognizes each client has unique needs that deserve tailored solutions based on desired outcomes. With offices in Los Angeles, Milwaukee and Baltimore, we bring a level of experience, expertise and proprietary analytics and technology unmatched in our industry to each client engagement. WBC possesses intimate knowledge and experience working with most of the Top 20 PBMs, including Optum and Catamaran. We understand their processes, coding. therapeutic classifications and pricing which enables us to be an effective and efficient audit resource to assist Fresno City Employees H&W Trust with this engagement. We expect an audit to be completed and a final report produced in approximately 120 days from the date we obtain a fully executed Services Agreement with the Trust. The Engagement Our understanding is that Fresno City Employees H&W Trust (“The Trust”) wants to examine the performance of their Pharmacy Benefit Manager (“PBM”) OptumRx (formerly Catamaran). At this time, we do not know the number of employee groups that might have different plan designs, but we believe the plans serve approximately 3,500 active and retired employees.

Through this proposal, WBC will demonstrate our auditing services that utilizes a proven, systematic approach. Our audit processes will include a review of pricing, plan design and rebates. Additionally, we can make available any PBM-related consulting project, including a PBM procurement, contract negotiation, clinical analysis and financial modeling.

WBC appreciates the opportunity to illustrate our company, consulting and audit solutions for the Trust. This proposal will give you a better sense of how WBC’s PBM consulting

services holds PBMs accountable and helps plan sponsors maximize the value of their pharmacy benefits to their members.



IV. Why WBC/TRICAST?

Proprietary Software: AccuCAST™, BidCast™ and Reveal™

Our proprietary software tool, AccuCAST™, reports and audits all pharmacy claims to assesses financial performance by performing a detailed analysis utilizing 100% of your pharmacy claims for the audit period. This audit includes an analysis of pricing and discount guarantees and is designed to thoroughly examine the PBMs financial performance by validating the following parameters against contractual requirements:

• Network discount guarantees for brand and generic, including retail and mail • Discount claims • Actual discounts received (brand and generic) • Administrative fees • Maximum Allowable Cost (MAC) drugs (including overall generic discount) • Single source generics (including recent brands off patent) • Specialty drug discount guarantees • Brand and generic dispensing fees (Retail and Mail) • Average wholesale price (AWP) discounts

Additionally, a Plan Design Audit determines how your plan is adhering to the plan design features and requirements in your contract. Through this analysis, we will assess and validate:

Proper adjudication of copayments and coinsurance Administration of quantity limits, day-supply maximums, formulary exceptions

and prior authorizations Uncoordinated Claims, such as Medicare and subrogation Formulary coverage Duplicate claims Fraud, Waste & Abuse oversight (including compounding review) Dispense As Written overrides

We have also developed our BidCAST™ software to assist in the benchmarking and evaluation of RFP responses from PBMs. This tool enables us to provide a detailed analysis of a PBM’s proposal based on its operational, financial and technical merits.

For plan sponsors who want to take a more active role in monitoring the ongoing performance of their PBM, we offer Reveal™, a tool that enables plan sponsors to replicate the claims adjudication engine of their PBM so they can see, in near real-time, exactly what is happening in their plan. This continuous oversight and maintenance provides actionable feedback so the plan can take corrective measures when problems



occur, rather than having to wait for a retrospective analysis that is provided through the normal audit function.

Industry Experts Our group is composed of leading experts in the pharmacy benefit field. This includes senior consultant practice leaders and former PBM insiders who have held positions ranging from CEO to operational management in areas that include Clinical Operations, Client Management, Contracting, Account Management and Mail Order. As recognized leaders in the pharmacy benefit consulting field, WBC is often called upon by plan sponsors, private equity firms, law firms and pharmaceutical manufacturers. Additionally, TRICAST has performed PBM audits for more Blue Cross/Blue Shield plans, and more state employee groups than any firm in our field. Independence from PBMs We operate independently of the PBMs we review and audit. There is never a conflict of interest and we never accept compensation from the PBMs in question. We will also include a compensation disclosure affidavit in our services agreement. Many of our competitors refuse to offer this safeguard. Our independence and objectivity is recognized by the PBM industry, and WBC/TRICAST is one of the few auditing firms that is approved to perform both pricing and rebate audits. Experience with Public Sector Health & Welfare Funds Our team has worked with numerous state governments, multi-employer and state agency employee groups. We understand how a jointly-trusteed H&W Fund operates. We are also very familiar with the negotiation, public disclosure and bidding requirements that many public entities must adhere to in vendor procurement, in addition to state and local statutes related to any unique pricing guidelines or pharmacy access requirements. In-depth Knowledge of PBM Data Processing and Reporting The reconciliation process and reporting systems utilized by PBMs can be unique and complex. We are very familiar with the Optum process and our ability to safely and securely work with their data feeds will help streamline this assignment. We will work as the Trust’s advocate in making sure their PBM is responding within acceptable timelines and can help refine any ambiguity within the current contract.



Intimate PBM Knowledge

TRICAST hosts an annual on-site PBM roundtable. During the event, executives from 10 - 12 PBMs discuss industry trends, future factors impacting health care and what differentiates their services from other PBMs. Through these roundtable events, we can better serve our clients by learning how PBMs re-price claims, improve audit process efficiencies and build relationships with PBM executives for expediting any problematic client issues. This experience gives us a unique perspective and advantage in the market. Most importantly, it allows us to efficiently and effectively guide clients through the audit process and assists us in resolving disputes with your PBM. Best Practice Standards Our TRICAST software has been built with pharmacy best practice standards in mind. It provides us immediate, quantitative feedback on claims needing further action and anomalies in the application of plan design requirements. Our consultants offer a focused perspective on the pharmacy benefit market that, through their experience and expertise, recognize any deviations from industry best practices. When this occurs, we are better positioned to make recommendations that will hold your PBM to accountable standards and enhance the value of the Trust’s pharmacy benefit. Additionally, our software handles even the largest data files using the most secure HIPAA-compliant data transfer protocols.



V. Services Descriptions In a Pricing Audit, we assess financial performance by performing a detailed analysis utilizing 100% of your pharmacy claims for the audit period. The Pricing Audit includes an analysis of discount guarantees and is designed to thoroughly examine the PBMs financial performance by validating the following parameters against contractual requirements:

• Network discount guarantees for brand and generic, including retail and mail • Discount claims • Actual discounts received (brand and generic) • Administrative fees • Maximum Allowable Cost (MAC) drugs (including overall generic discount) • Single source generics (including recent brands off patent) • Specialty drug discount guarantees • Brand and generic dispensing fees (Retail and Mail) • Average wholesale price (AWP) discounts

After receiving the current pricing information, we will compare the brand name drug pricing and discount analysis. WBC will also compare the AWP per unit charged for the National Drug Code (NDC) adjudicated on the dispensing date with Medi-Span® National Drug Data File in effect on that date. Any pricing anomalies are available within the report, and drill-down capabilities illustrating further detail can be made available. Our systems and procedures can identify these potential pricing errors:

• Incorrect discounts applied to drug types • Inaccurate contracted price basis Usual & Customary rule not applied to claim

price • Outlying patterns of drug use inconsistent with average utilization • Missed minimum pricing guarantees across claims • Rebates not consistent with per-paid prescription guarantees

A. Pricing Audit Components

We will utilize our proprietary software application tools to monitor 100% of the Trust’s prescription claims. Please see below for details on the components of the claims audit:

Perform a full contract review specific to the agreed-upon timeframe. Review 100% of paid claim transactions. Benchmark contract terms and pricing against best practices, market

norms and other similar size plans. Confirm that claims have been paid according to contract terms and

identify differences. Compare AWP used on claim file to Medispan Compare brand / generic classification used on claim file to Medispan



Confirm that claims reflect transitions consistent with current PBM pricing commitments and are consistent with actual claim charges.

B. Pricing Audit Deliverables We will provide the following pricing deliverables:

Summary of audit findings, including timeframe, number of claims, dollar amount of claims, and variance from PBM contract guarantees.

Claim Audit Report product that summarizes: Discounts and dispensing fees observed Appropriate brand / generic pricing designation (including single source

generics) Verify pricing logic Whether rebate dollars were paid correctly.

Plan Design Audit Description

Our Plan Design Audit determines how your plan is adhering to the plan design features and requirements in your contract. Through this analysis, we will assess and validate:

Proper adjudication of copayments and coinsurance Administration of quantity limits, day-supply maximums, formulary exceptions

and prior authorizations Uncoordinated Claims, such as Medicare and subrogation Formulary coverage Duplicate claims Fraud, Waste & Abuse oversight (including compounding review) DAW overrides

A. Initial Reporting

Throughout the audit process, Optum, Trust consultants and the Trust will be kept informed of our progress with ongoing Status Reports. During these meetings, project progress, clarifications or issues and next steps will be discussed. Audit reports detailing the audit findings will be provided to Optum and the Trust’s consultants following the PBM Audit. Claims will be grouped into separate categories of discrepancies and presented with line-item detail by claim. The reason as to why the error happened and recommendations to prevent future occurrences will be provided. In addition, an executive summary encompassing all results will be presented at the conclusion of the audit. Our initial findings will be provided to Optum and the Trust’s consultants (unless prohibited by the Trust’s current PBM contract) prior to the completion of the final report in order to clear up any discrepancies, and to give the vendor the



opportunity to provide additional information that may have been omitted from the initial request or provide additional clarification. Each section of the Executive Summary provides a narrative of the category detail to note findings of significance as well as to make appropriate recommendations for future corrective action. Overall amounts of overcharge are provided in our report and per-claim detail is available through our drill-down capabilities within each report. This report will constitute the basis for the Trust to request reimbursement of overpayments.

B. Final Audit Reporting Upon review of 100% PBM claims data, the final audit report will be shared with the Trust. Our audit findings and deliverables will include:

a. Summarize the audit results in our Executive Summary which will include and support our recommended recovery and/or follow-up actions.

b. Review the findings of the audit in detail. c. Identify and prioritize improvement and/or recovery opportunities based on

materiality of savings and service impact; and, d. Identify key opportunities (problems and recovery opportunities to be

addressed) for immediate savings and or those achievable through improving the quality of administration.

Rebate Audit – Optional

Our Rebate Audit is an optional service for plan sponsors that want to analyze and assess the total scope of rebate payments. It is performed on-site at the PBM’s offices and involves the auditor’s review of actual manufacturer’s contracts with the PBM and

reconciled with the payments received by the plan sponsor. There are only a few consulting groups that have been approved by multiple PBMs to perform both retrospective pricing audits and rebate audits. We are one of those groups.

For most clients, we advise that a separate rebate audit be considered only after an evaluation has been performed in their PBM services’ agreement and a preliminary review of the claims data. If the language in the existing contract is too pliable in a way that advantages the PBM, then it will be very difficult to illustrate a shortfall and obtain a recovery for the client. We will, however, be able to make a rebate assessment as part of our pricing audit as described above. This process will confirm whether the rebates received are consistent with the contracted terms in the client’s services agreement and

whether plan utilization is reflected in the rebates obtained.



Steps to Commence the Audit Process:

1. Completion of appropriate confidentiality agreements and BAA. 2. An initial client kick off meeting (teleconference or in-person) to review

program scope objectives, timeline, history, program nuances, data required by the plan and PBM.

3. A detailed kick off meeting with Optum to review data requirements, exchange protocols, review of Optum’s obligations and expectations, timeline for data generation, findings review and generation financial reconciliation files and internal findings.

4. Receipt and analysis of data files received by WBC/TRICAST for accuracy and analysis

5. A call with Optum to verify data accuracy 6. A call with the client or consultant to verify data is accurate and

WBC/TRICAST can commence the next phase of the audit process. Plan Resources

Availability for the kick off meetings, bi-weekly calls to verify audit status Ability to share pertinent files, contracts and PBM contact information

PBM RFP and Management

Our management of the RFP review and procurement process begins with a thorough examination of your PBM Services Agreement. The terms, definitions and conditions will dictate the financial performance of your pharmacy benefit. A customized RFP document will be drafted to reflect the business practices and objectives that reflect the best interest of The Trust and your employees. As part of that document will be a model contract that will require potential vendors to acknowledge acceptance as part of their proposed offering. We will manage the creation of the documents, distribution, managing responses, evaluating and scoring proposals, conducting finalist interviews and assisting the Trust with a final selection for the award.

We also manage the implementation of the new contract and can provide ongoing maintenance and oversight of the plan’s performance. Our proprietary software enables

us to provide this level of support for both regular prescriptions and Specialty drugs, including specialty drugs distributed from both the pharmacy and medical benefit in your plans.



VI. HIPAA Security Data Security to Protect PHI Data security is of utmost importance with our client engagements. Our staff has been trained in HIPAA compliance and are re-trained annually. In addition, HIPAA Policy and Procedures are in place for employees to follow. We securely protect data in-transit and data at-rest. HIPAA Compliance Policy and Procedures Although many of our reports and applications contain patient and client specific information, TRICAST has implemented internal and external procedures to maintain HIPAA compliance. This insures that nothing is given to any client or involved party that will violate client confidentiality. All the applications have TLS certificates encryption. All of the classified private information is password protected and encrypted. We are administrators and hold millions of member months on eligibility and claims information. We do provider profiling with full HIPAA compliance. We also institute a multi-tier defense structure in order to provide data security. Layers of security include perimeter and internal based firewalls, malicious software protection, strong authentication, encrypted data transmission using128-bit VPN tunnels and use of the public key infrastructure. TRICAST institutes a multi-tier defense structure in order to provide data security. Layers of security include perimeter and internal based firewalls, malicious software protection, strong authentication, encrypted data transmission using 128-bit VPN tunnels and use of the public key infrastructure. Hardware/Back-up/System Security is under constant scrutiny by our staff. All data and system backups are loaded and available off site, with weekly synchronization in addition to our on-site redundant system. Hardware is upgraded on an as needed basis. Typical server replacement is currently on a yearly rotating schedule. Contracted software is under version control and all our development software is updated monthly through our subscription support. Encryption Algorithm To protect sensitive information during transmission, TRICAST employs Sophos SafeGuard AES-256 encryption at rest, MoveIt/IPSwitch secure file transfer. Encryption keys are managed with tools that vary by encryption method (PGP, SFTP, HTTPS, etc.). TRICAST has implemented technology and processes to force encryption of information contained within a portable storage device. Portable storage devices include several mobile technologies capable of extracting and/or storing information (e.g. USB drives, writeable software. etc.). Once encrypted, the information on a portable storage device will securely limit access to only those personnel with designated authorization. This automated encryption is intended to secure the information against unauthorized disclosure.



Conclusion WBC would like to thank you for the opportunity to provide information regarding our company and our services. The services offered in this proposal provides your plan and its members the assurance that your Pharmacy Benefit Manager is being held accountable for its performance. If you have any questions regarding this proposal, please contact Roy Wilkinson by email at [email protected] or by phone at 410-905-1463.

mailto:[email protected]



Exhibit A

Summary of Fees

(Estimates)

Product/Service Cost

Pricing Audit $30,000

Plan Design Audit Included

TOTAL $30,000

Product/Service Cost Rebate Audit (Optional) $31,000

PBM RFP and Management $35,000 Consulting Hourly Rate $300/hour

Assumptions:

Member count of up to 4,000 active and retired employees 2 unique plan designs included in the audit These fees are estimates based on our understanding at this time. They may be

increased or decreased once the project’s Statement of Work is fully scoped prior to engagement.



Exhibit B

Key Staffing

ROY WILKINSON, RHU, REBC – Project Manager and Senior Consultant

EXPERIENCE Roy is the founder and serves as President and CEO of Wilkinson Benefit Consultants, Inc. (“WBC”) a Los Angeles-based consulting firm that focuses exclusively in pharmacy benefit consulting. WBC was founded in Baltimore, Maryland in 1991 and works with a diverse clientele of corporate, Taft-Hartley and public sector pharmacy benefit plan sponsors. WBC represents clients in negotiations with their PBMs and provides consulting and strategic planning regarding plan design, contract analysis, vendor performance, clinical guidance, formulary analysis, vendor procurement, financial modeling and plan auditing.

Previously, Mr. Wilkinson served as Practice Leader of Health & Welfare for Milliman in New York City, a global actuarial and benefit consulting firm. Additionally, Roy has served as Western Region Health Practice Leader for Segal Consulting, a national actuarial and benefits consulting firm. He was very active in shaping the pharmacy work for the region and headed consulting projects regarding retiree subsidies and EGWP analysis.

EDUCATION Business Administration - Pennsylvania State University Master of Health Administration – Massachusetts College of Pharmacy and Health Sciences (Degree to be awarded in 2018) PROFESSIONAL DESIGNATIONS Registered Health Underwriter Registered Employee Benefit Consultant ___________________________________________________________________

GREGORY RUCINSKI, R.PH, Senior pharmacy benefit consultant

EXPERIENCE Greg has dedicated the last 35 years to the pharmaceutical industry. He is the Founder



and President of TRICAST and leads all aspects of consulting services for the pharmacy benefits practice.

Prior to joining TRICAST Greg spent ten years as President and CEO at SPS – a pharmacy benefit management company and specialty mail order provider focused on large self-funded groups. He also worked nine years at Serv-U, a Wisconsin-based pharmacy chain, where he held positions as Director of Marketing, Advertising and Professional Affairs and Managing Partner.

Gregory has served as pharmacy consultant to a number of large health plans, has partnered with many reinsurers and served as guest speaker for industry events.

EDUCATION Bachelor of Science – University of Wisconsin School of Pharmacy

PROFESSIONAL DESIGNATIONS Registered Pharmacist

SCOTT M. MORGAN, R PH., Vice President of Pharmacy Services and Senior Clinical

Analyst

EXPERIENCE Scott is a registered pharmacist with more than 30 years of industry experience. As Vice President of Pharmacy Services, he is responsible for the implementation of business opportunities for the fully insured and self-insured prescription insurance programs, coordination and implementation of customer audit and eligibility reviews, and management of daily operations of pharmacy benefits. This includes oversight and development of drug formularies prior authorization guidelines and management of customer service administrators.

Previously, Scott was Clinical Pharmacy Manager at UnitedHealthcare of Wisconsin. He also dedicated over 10 years at Eli Lilly and Company in a variety of roles including Healthcare Accounts Manager, Primacy Care and Neuroscience District Sales Manager and Business Analyst for National Healthcare Accounts. Scott also spent time at Methodist Hospital of Indiana in Indianapolis as staff pharmacist and as co-owner of Morgan Pharmacies – also in Indianapolis.

EDUCATION Bachelor of Science in Pharmacy – Purdue University School of Pharmacy



PROFESSIONAL DESIGNATIONS Registered Pharmacist

Member – Wisconsin Academy of Family Physicians (WAFP)

Member – Academy of Managed Care Pharmacy (AMCP)

STACY AUSPRUNG, Director, Client Services

EXPERIENCE Stacy has nearly 15 years of experience in the healthcare industry. As Senior Business Analyst, she conducts data analysis, develops client reports and deliverables and communicates all project expectations to team members and key stakeholders. Stacy also analyzes and generates audit reports, troubleshoots and consults with clients on audit findings.

Prior to her current role, Stacy held a number of positions at Medco Health Solutions including Marketing Coordinator, Business Support Analyst and Account Coordinator. Stacy excels at cross-divisional communications, project management and customer service.

EDUCATION Bachelor of Business Administration – University of Wisconsin Madison

__________________________________________________________________

REGINA M. ACKLEY, Senior Business Analyst

EXPERIENCE Regina has more than 17 years of experience in the healthcare industry and pharmacy benefit management. With a strong focus on data analytics and account management, she mentors a team of business analysts and performs troubleshooting of data and reporting issues.

Regina has held various business analysts and account management roles at Serve You Custom Prescription Management and Systemed/Medco Health Solutions.

EDUCATION Bachelor of Science in Business Administration – Mount Mary University



Exhibit C

References

In order to maintain our clients’ privacy and minimize the number of distractions during their day, we will provide references upon request when a prospective new engagement escalates beyond a general interest. Thank you.



Exhibit D Certificates of Insurance



This Page Is Blank


MAILING ADDRESS

621 Santa Fe TELEPHONE (559) 499-2450 P.O. BOX 45018

Fresno, CA 93721 FAX (559) 499-2460 FRESNO, CA 93718-5018


Agenda for the Regular Board Meeting

January 11, 2017

8:00 AM

Location: HealthComp 621 Santa Fe, Fresno CA 93721*

Employer Trustees-City of Fresno Employee Trustees Bruce Rudd, Vice Chairperson Shane Archer, Chairperson FFA Michael Lima, Trustee Jacky Parks, Trustee FPOA Jeffrey Cardell, Trustee Apolonio Munoz, Trustee ATU William Dearsan, Trustee

Martin Hinojosa, Trustee IBEW FCEA

Administrator Robert Mesel, Trustee CFPEA Phil Musson, CEO Shelley Morrison, Trustee CFMEA Michelle Bugg, Plan Manager Mike Alforque, Trustee FFA Marina Magdaleno, Trustee Local 39 Jo Billings, Trustee FPOA Vacant FAPSS

Legal Counsel Consultants

Michael E. Moss, Esq. Jim Rhein Rael & Letson

Roll Call 8:00 A.M.

1) Approval of Agenda**

Approve Agenda for January 11, 2017

Action as required

2) Public Discussion***

3) Consent Calendar

All Consent Calendar items are considered to be routine and will be treated as one agenda item. The Consent Calendar will be enacted by one motion. There will be no separate discussion of these items unless requested by a Board of Trustee Member, in which event the item will be removed from the Consent Calendar and will be considered as time allows.

a) Approval of the Minutes of November 9, 2016

b) Approval of the Pacific Union Dental/United HealthCare Renewal effective July 1, 2016

Action as required

4) General Calendar

a) Financial Projections for the 2017-2018 Fiscal Year

Review of the Financial Projections for the 2017-2018 Fiscal Year

Fresno City Employees January 11, 2017 Health & Welfare Trust Regular Board Meeting Agenda 2

b) Cost Analysis Report for the Requested Benefit Changes for the 2017-2018 Fiscal Year

Review of the Cost Analysis Report and Approve the Requested Benefit Changes for the

2017-2018 Fiscal Year

Action as required

c) Contribution Rates for the 2017-2018 Fiscal Year

Consider and Approve Contribution Rates for the 2017-2018 Fiscal Year

Action as required

d) Submission of Request for Plan Document Changes for the 2017-2018 Fiscal Year

Consider Plan Document Changes for the 2017-2018 Fiscal Year

Action as required

e) Vendor Rate Submission

Review and Approve Vendor Rate Submissions

Action as required

f) Retain Prescription Benefits Consultant

Consider and Approve Consultant

Action as required

5) Review & Approval of Appeal Interpretations, Report from Appeals Committee

6) Attorney’s Report

a) Affordable Care Act

Update on the Affordable Care Act

7) Board Meeting Schedule

a) Consider and Approve Modification to Board of Trustee Meeting Schedule

Action as required

8) Executive Session


CLOSED SESSION – CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATION Paragraph (4) of Subdivision (d) of Section 54956.9

9) Informational Materials

a) The University of California at Berkeley Wellness Letter

b) HealthComp Administrator’s

i) Claim and Benefits Reports

ii) Specific Stop-Loss Report

iii) Turnaround Time Report

c) Blue Shield of California

d) Psy-Care

December 2016 Utilization Reports

Fresno City Employees January 11, 2017 Health & Welfare Trust Regular Board Meeting Agenda 3

e) United HealthCare

f) Optum

i) Executive Summary

November 2016 Executive Summary

ii) Prior Authorization Report

December 2016 Prior Authorization Report

g) Delta Dental

November 2016 Experience Reports

h) ChiroMetrics

December 2016 Intake Reports

i) PhysMetrics

December 2016 Intake Reports

j) MES Vision

10) Future Agenda Items

11) Adjournment

Action as required *The meeting room is accessible to the physically disabled. If you require a disability related modification or accommodation to participate in the meeting, notify HealthComp Administrators at (559) 499-2450.

** All writings, including Agendas, distributed prior to or during any Regular or Special Meeting are available for public inspection during regular business hours at the offices of HealthComp Administrators located at 621 Santa Fe, Fresno CA.

***Provides an opportunity for members of the public to address the Board of Trustees on items of interest to the public within the Board of Trustees jurisdiction and which are not already on the Agenda. It is the policy of the Board of Trustees not to answer questions impromptu but refer such matters to the Administration Office for placement on the next Agenda. Speakers should limit their comments to no more than three (3) minutes. No more than ten (10) minutes per issue will be allowed. For items which are on the Agenda for this meeting, members of the public will be provided an opportunity to address the Board of Trustees before a vote is taken on each item.

NOTICE APPEALS COMMITTEE

Next Meeting: Monday, January 30, 2017 at 4:00 p.m.

Committee Members to Attend: Michael Lima, Mike Alforque, Apolonio Munoz

Report Period

02/01/2017 to 02/28/2017

Average Enrollment 8,899

Members Accessing Benefit 72

Total Certifications 74

Total Access Rate 0.83 %

Total benefit use per/1000 8.32

Certifications Summary # %

Mental Health Outpatient 73 99 %

Mental Health Inpatient 0 0 %

Substance Abuse Outpatient 1 1 %

Substance Abuse Inpatient 0 0 %

Other 0 0 %

Total 74

Previous Year

02/01/2016 to 02/28/2016

8,616

66

75

0.87 %

8.70

Page 1Confidential and Proprietary

Carve-Out Utilization Report

Psy-Care: Fresno City Employees Health & Welfare Trust2/1/2017 to 2/28/2017

Benefit use per 1000

Mental Health Outpatient

New Outpatient Therapy 6.18

Medication Evaluation / Management 1.80

Outpatient Continued Treatment 0.00

Psychological Testing 0.11

Behavioral Health Treatment 0.11

Neurofeedback 0.00

Biofeedback 0.00

Crisis Intervention / Stabilization 0.00

ECT (Electroconvulsive Therapy) Outpatient 0.00

rTMS (Transcranial Magnetic Stimulation) 0.00

Mental Health Inpatient

Nursing Home Consultation 0.00

Intensive Outpatient 0.00

Partial Day 0.00

Residential 0.00

Inpatient Voluntary Admission 0.00

Inpatient Involuntary Admission 0.00

ECT (Electroconvulsive Therapy) Inpatient 0.00

Substance Abuse Outpatient

Intensive Outpatient 0.11

Outpatient Detoxification 0.00

Substance Abuse Inpatient

Residential 0.00

Inpatient 0.00

Partial Day 0.00

Inpatient Detoxification 0.00

Other

Other 0.00




Mental Health Outpatient

Certifications UniqueMembers

AverageSessions Used

New Outpatient Therapy 55 54 0.1

Medication Evaluation / Management 16 16 0.3

Outpatient Continued Treatment 0 0 0

Psychological Testing 1 1 0

Behavioral Health Treatment 1 1 0

Neurofeedback 0 0 0

Biofeedback 0 0 0

Crisis Intervention / Stabilization 0 0 0

ECT (Electroconvulsive Therapy) Outpatient 0 0 0

rTMS (Transcranial Magnetic Stimulation) 0 0 0

73 71 0.1







Mental Health Inpatient

Admissions UniqueMembers

AverageDays / Sessions

Certified

Nursing Home Consultation 0 0 0

Intensive Outpatient 0 0 0

Partial Day 0 0 0

Residential 0 0 0

Inpatient Voluntary Admission 0 0 0

Inpatient Involuntary Admission 0 0 0

ECT (Electroconvulsive Therapy) Inpatient 0 0 0

0 0 0










Substance Abuse

Admissions UniqueMembers

AverageDays / Sessions

Certified

Intensive Outpatient 1 1 15.0

Residential 0 0 0

Inpatient 0 0 0

Outpatient Detoxification 0 0 0

Partial Day 0 0 0

Inpatient Detoxification 0 0 0

1 1 15.0







2 8 0 0 C A M P U S D R I V E , S U I T E 1 5 0 S A N M A T E O , C A L I F O R N I A 9 4 4 0 3

T E L E P H O N E ( 6 5 0 ) 3 4 1 - 3 3 1 1 F A X ( 2 0 6 ) 4 4 5 - 1 8 4 0

W W W . R A E L - L E T S O N . C O M

February 28, 2017

Board of Trustees


Re: Fee Increase

Dear Trustees:

Our fee arrangement ended May 31, 2015 and we respectfully request an increase in our retainer,

effective June 1, 2017. The challenge that our health care system imposes on us all continues to

result in more time on our part in efforts to assist you with your decision-making.

We last entered into a fee agreement with the Fresno City Employees Health and Welfare Trust

on June 1, 2012. At that time, we agreed to a fee of $5,500 per month from until June 1, 2013,

and $5,600 until June 1, 2014, and finally $5,650 until June 1, 2015. Our current monthly

retainer of $5,650 per month is the same amount as it was on June 1, 2014. We are requesting an

increase to $5,900 per month effective June 1, 2017, $6,100 per month effective June 1, 2018

and $6,300 per month effective June 1, 2019.

I hope you have found our service to be thorough and responsive. I like to think that my

reporting provides you with a full understanding of each important issue. It is truly a pleasure

working with you, something I enjoy very, very much. Thank you in hopes of your favorable

consideration.

Sincerely,

Jim Rhein

JR:cn

http://www.rael-letson.com/

0 - Fresno City Trust

TELADOC,

January 2017 Teladoc Utilization Report

Primaries 3,307 12 24 0.73%

Dependents 6,176 11 17 0.28%

Total Eligible Lives 9,483 23 41 0.43% 6

Percentage 0.24% 1.24%

Eligible Lives; All members with access to the service (primaries and dependents)

YTD Primaries 3,307 199 24 0.73%

YTD Dependents 6,176 188 17 0.28%

YTD Total Eligible Lives 9,483 387 41 0.43% 6

YTD Percentage 4.08% 1.24% - -- --- - -

Annuahzed Ullhzatton% 14.138%

VISIT SUMMARY

•• . •• Office VIsit 38 $186.00 $7,068 Total# Vls!ts 41

Primary Cam 13 #Visits with Rx 32

Specialist 0 #Visits with no Rx 9

Urgent Care CHnlc 25 %VIsits with Rx 78%

Emergency Room $2,656,00 $2,656 Total# Rx 47

No Treatment 2 -$45.00 -$90 Avg # Rx Per VIsit 1.1

Total Visits 41

azilhromycln 250 mg oral tablet Acute s!nus!tls, unspec!fied

methylPREDNISolone 4 mg oral tablet Acute upper respiratory lnfecUon, unspecified

albuterol 90 mcgnnh Inhalation aerosol Acute bronchltls, unspecified

Amoxic!Uin 400 mg/5 ml oral powder for reconstitution Acute maxillary sinusitis, unspecified

Augmentln 875 mg·125 mg oral tablet Cough

*Episode of care savings are national averages based on research conducted by Veracity Healthcare Analylics and represent the net savings of a 30· day episode of care . .. Claim Savings only captures estimated total claim Impact and does not Include monthly administrative fees.

Increase utilization by communicating the Tefadoc service to members. Visit htlp:/lteladoc.mymarketingbench.com/ to download customized member communications.

(c) 2017 Teladoo, Inc. Proprietary and Confidential Page 1 of 1

0 - Fresno City Trust PPO High Option

TELADOC.


Primaries 2,589 8 20 0.77%

Dependents 5,007 10 16 0.32%

Total Eligible lives 7,596 18 36 0.47% 6


Eligible lives: All members with access to the service (primaries and dependents)

YTO Primaries 2,589 157 20 0.77%

YTD Dependents 5,007 171 16 0.32%

YTD Total Eligible lives 7,596 328 36 0.47% 6

YTD Percentage 4.32% 1.39% -

Annualized Uhllzatlon% 16.69%

• - VISIT SUMMARY

Total# Visits 36

PrlmoryC<>re 12 # Vlslts with Rx 27

Specialist 0 #Visits with no Rx 9

Urgent Care CHn!c 21 % Vislls with Rx 75%

Emergency Room $2,656.00 $2,656 Totai#Rx 36

No Treatment 2 ·$45.00 -$90 Avg # Rx Per Visit 1.0

Total Visits 36

azlthromycln 250 mg oral tablet Acute sinusitis, unspecified

Amoxlciltln 400 mg/5 ml oral powder for reconstitution Acute upper respiratory infection, unspecified

Augmentln 875 mg-125 mg oral tablet Acute maxillary s!nusll!s, unspecified

beclomethasone 40 mcglinh Inhalation aerosol Acute bronchiolitis, unspecified

benzonatate 200 mg oral capsule Acute bronchitis, unspec!fied

*Episode of care savings are national averages based on research conducted by Veracity Healthcare Ana!ytlcs and represent the net savings of a 30-day episode of care . .. Claim Savings only captures estimated total claim Impact and does not Include monthly admtntstrallve fees.

Increase utilization by communicating the Tetadoc service to members. Visit http;llteladoc.mymarkettngbench.com/ to download customized member communications.

(c) 201 z Teladoc, Inc. Proprietary and Confidential Page 1 of 1

0 - Fresno City Trust PPO Medium Option

TELADOC.


Dependents 1,152

Total Eligible lives 1,881 5 5 0.27% 5


Ef!glble Lives: All members with access to the service (primaries and dependents)

YTD Primaries 709 41 4 0.56%

YTD Dependents 1,152 17 0.09%

YTD Total Eligible Lives 1,861 58 5 0.27% 5

YTO Percentage 3.12% 0.71% --- -- ---

Annuabzed UUhzaUoo % - 8.46%

_ ~ -, - _ c VISIT SUMMARY

•• . •• Office VIsit 5 $186.00 $930 Total# Visits 5

Primary Care #Visits with Rx 5

Speclallsl 0 #Visits with no Rx 0

Urgent Care CHn!c 4 %Visits with Rx 100%

Emergency Room 0 $2,656.00 $0 Total# Rx 11

No Treatment 0 -$45,00 $0 Avg # Rx Per Vls!t 2.2

Total Visits 5 $930

albuterol 90 mcgfinh Inhalation aerosol Acute bronchitis, unspecified

a!buterol CFC free 90 mcglinh Inhalation aerosol Acute sinusltis, unspecified

amoxlcl!lln 500 mg oral tablet Cough

azithromycin 250 mg oral tablet Other general symptoms and signs

benzonatate 100 mg oral capsule Urinary tract Infection, site not specified

*Episode of care savings are national averages based on research conducted by Veracity Healthcare Analytics and represent the net savings of a 30· day episode of care • .. Claim Savings only captures estimated total claim Impact and does not include monthly administrative fees.

Increase utilizaUon by communicating the Teladoc service to members. Visit hltp:fl!eladoc.mymarkelingbench.comi to download customized member communications.

{c) 2017 Tel~aoo, lncrF~'-~ Proprietary and Confidential Page 1 of 1

0 - Fresno City Trust PPO Low Option

TELADOC.


Dependents 17 0

Total Eligible Lives 26 0 0 0.00%

Percentage Q.OO% 0.00%

Eligible lives: All members with access to the service (primaries and dependents)

YTDPrlmaries 9 0 0.00%

YTD Dependents 17 0 0 0.00%

YTD Total Eligible lives 26 0 0.00%

YTD Percentage 3.85% 0.00% - ---------- -

Annualized U!1hzatJon % 0.00%

••. . VISIT SUMMARY

•• . ... Office Visit 0 Total# Vls!ls 0

Primary Care 0 #Visits with Rx 0

Speciatlst 0 #Visits with no Rx 0

Urgent Care CHnlc 0 %VIsits with Rx 0%

Emergency Room 0 Totai#Rx 0

No Treatment 0 $0.00 Avg # Rx Per VIsit 0.0

Total VIsits 0

"Episode of care savings are national averages based on research conducted by Veracity Heallhcare Analyt!cs and represent the net savings of a 3Dday episode of care. ••ctalm Savings only captures estimated total claim Impact and does not Include monthly administrative fees.

Increase utitfzatlon by communicating the Teladoc service to members. Visit http://teladoc.mymarkeUngbench.com/ to download customized member communications.

(c) 2017 Telaaoc; Inc:~~~· Proprietary and Confidential Page 1 of 1

· : .:z University of California,

Well ness

~~~~~.~h~~~~~it~a~n~dii~Nc~~;~ ~:~i~:!i~f~i:~~· 'I _·$UQar·.!eVeis·:-'that are .elevated 'but -not

·~enough to be considered diabetes. The study, in theAnnalsofFamiiyMedicine, found that among. healthy;weightadultsages 20 and older, pre· .

· diabet~s··preval~~~e incl-e_~sed _ over~fl.~roin: 1 o, _ _. _ ~ percent in )9SS-91to ,19 percent in '2oi.(J 2: •'. ' Amonfi thbse··4s ·and Older, it iOCreaS~d frOm; ... 22 to 33 percent.The u.s. Preventive ServiCes · Task F6ri:e -recoinmends ·blood sl.i'gar'Sdeen::. , lng only for overweight or obese people ages · 40 to 70. These new findings mean that many people with prediabetes are being missed.

m Potato intake is not associated with higher risk of heart attacks, stroke, or heart failure, according to a 13·year study of 69,000 Swedes, published In the American Journal of Clinical Nutrition In December. However, a study of 187,000 American health professionals, in the journal BMJ in May, found that those who. ate the most pOtatoes· (at least four_ servings a· "Ye~k~. were_ at mOdestly increcised risk for developing '' ~ypertenslon over the course of a deCade :or'. · · two. One difference betWeen the studies: The ' Swede! '~te mostly boiled potatoes,· while. · ·' ·Americans tefld to eat more Frerlcli fries, whichare usually heavily salted and have beenlinked

_-to a Y~rietyofxisks in previous resea~¢h_._pot_a-:;_ . toes ha~edir;t,a,Y pluses (notably potassium and .. , · fiber) and minuses (relatively high calories for a vegetable and, depending on how they are piepared and eaten, a rapid effect on blood sugar).

El Caffeine does not cause premenstrual syn~ drome (PMS), suggests a largestudy In the American Journal of Clinical Nutrition. Women who consumed the moSt caffeln~ {moie than 540 milligrams a day, the amount In about five cups of coffee) were no more likely to develop PMS over 14 years than those who consumed almost none. "Our results, In conjunctl~n with those of other studies, suggest that current rec: ommendations to reduce or eliminate caffeine to prevent PMS may be unnecessary; the Har-

. vard researchers-cOncluded.

.,-.

Objects that changed our health The start of a new year Is a good time to look at the greatest (health) stories ever told

Glow-in-the-dark watches, horseshoe crabs, fly swatters, spittoons, gin and tonics, bicycle helmets,

American cheese, lab rats, bulldozers, birth certificates, and Joe Camel. You may not think these sundry objects have anything in common. But, along with 89 others, they make up the "100 Objects That Shaped Public Health," an engaging and thought-provoking list recendy compiledby the Johns Hopkins Bloomberg School of Public Health in honor of its 100-year anniversary. The chosen objects ''tell some of the most compelling stories of public health over the last century and help us appreciate its vast reach," according to the Hopkins website. Here, briefly, are just some of our favorites, for the wide-ranging impact they've had:

Ill The mosquito net. Simple and cheap ,-,-.=,.-----,-.,-., ($2.50 apiece), insecti

cide-treated nets effectively protect against malaria, dengue, and other viruses transmitted by mosquitoes.

Their use has saved coundess lives in developing countries that lack costlier resources to combat insect-borne diseases. Other low-tech items on the list with similar benefits include window screens and the ever-humble fly swatter.

Ill The Pill. Since the 1960s, the revolutionaty use of oral contracep

tives has allowed women to plan their pregnanCies and control the size of their families. This birth control

method is credited with lowering birth rates and improving the health of infants and mothem around the world. Con-

dams, which became popular after World War I, also made the list for their crucial role in preventing many sexually transmitted infections, in addition to pregnancy.

!!! The bifurcated needle. This small two-pronged steel needle played an oversized role in ending smallpox. Used during the World Health Organization's Global Small

pox Eradication Program from 1966 to 1977, its special design (which, unlike a hypodermic needle, just lighdy pricks the skin) allowed the vaccine against this dreaded disease to be delivered more effectively and efficiendy. Of course, this object. is just one key element in the broader public health achievement of vaccines, which over the past century have been responsible for eliminating polio in the U.S. (and most of the rest of the world) and for preventing misery and deaths from measles, whooping cough (pertussis), chickenpox, and other infectious diseases, as well as birth defects from rubella.

Ill The tamper-resistant cap. Required since 1970, this innovative (though often frustrating) package design saved more than 900 children from accidental poisoning deaths

from aspirin and oral prescription medications over the following two de.cades, according to calculations made by the U.S. Consumer Product Safety Commission. These hard-to-open caps are also found on bottles of bleach and other hazardous household substances. (Still, thousands of

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Blood pressure and the brain ~~ Carbon monoxide !il Spinning l!ll Better bacon choices?

I

continued from previous page children get their hands on dangerous materials every day, with dire consequences for many of them.)

fill Fluoride toothpaste. The discovery in the mid-20th century that fluoride makes teeth resistant to decay is hailed as one of the greatest breakthroughs in dentistry,

saving millions of children a year (and plenty of adults too) the ordeal of the dental drill. Besides its addition to community water supplies across the nation, fluoride is now the active ingredient in 95 percent of toothpastes in the U.S., beginning with Crest in 1955.

Jil The refrigerator. By slowing growth of harmful bacteria in food, this now-ubiquitous household item (at least in industrialized nations) is credited, in large part, with significantly reducing food-borne infections in the U.S.

l!l The speed limit sign. Excess vehicle speed is a major factor in road crashes. The speed sign, first introduced in 1901 in Connecticut (12 to 15 mph), is now required in nearly ail states. They reaily help: As a 2009 study reported, there was a 3 percent increase in

Many of the 100 Hopkins objects go hand·ln·hand with the CDC's "Ten Great Public Health Achievements in the 20th Century," which include Infectious disease control (notably immunizations}, motor vehicle safety, workplace safety, safer and healthier foods, family plan· ning, and reduction of tobacco use.

The CDC called these achievements a reminder of "how far we've come, how we got here, and exactly what public health Is: the active protection of our nation's health and safety, credible information to enhance health decisions, and partnerships with local minorities and organizations to promote good health:'

As the agency noted, we can thank such achievements In public health for a 25-year increase in life expectancy in the U.S. since 1900.

traffic deaths after Congress repealed the ma.-cimum federal speed limit (55 mph) in 1995, which led to higher speed limits nationwide. Other objects that have contributed to great advances in road safety include traffic lights, seat belts, airbags, children's car seats, bike lanes and helmets, and even sidewalks.

Ill The sidewalk. These walkways keep pedestrians safer (by reducing the chance they will get hit by vehicles) and healthier (by making it easier for them to walk, rather than resort to driving everywhere). Studies suggest that more "walkable" neighborhoods encourage residents to be more physicaily active.

1!1 ';Vaminglabels on cigarettes. Cigarette packs have carried a

"Caution: Cigarette Smoking May Be Hazardous to Your Health" warning since 1965. Better for help

ing people quit, however, are the pictorial labels used in more than 100 countries and territories, which show stark images of diseased hearts and lungs, people with gangrene and on ventilators, premature babies, decaying teeth, tracheotomy holes, and more. Shamefully, a proposal by the FDA to require specific pictorial warnings on cigarette packs in the U.S. was stymied in 2013 when tobacco companies successfully chailenged it. However, a federallawsuit filed in October by pediatricians, anti-tobacco activists, and groups representing heart and cancer speciailsts has reignited the issue, chailenging the FDA to issue a final rule requiring such labels.

Public (health) enemies Not all of the objects on the Hopkins list have had a positive impact. Q\lite a few have made us sicker and less safe or have hurt the environment. Among them: Joe Camel (the cartoon camel that made smoking cool to kids), tanning beds (which increase the risk of skin cancer and are especially popular with teenage girls), the Big Gulp (which ushered in the age of super-sized sugar-laden drinks), and leaded gasoline (which contaminated our air, water, and soil, leaving traces that still linger). Some, like thalidomide, asbestos, and flame retardants, may have had

2 January 2017 University of California, Berkeley Wellness Letter

good intentions when developed or first used but later turned out to deliver more harm than benefit.

Still, some good has come out of even the most controversial objects, by initiating cascades of events that ultimately led to policy changes. The.indiscriminate use of the pesticide DDT, for instance, inspired the environmental movement, while the unsafe 1960 Chevrolet Corvair led to the creation of the National Highway Traffic

-Safety Administration.

From objects to actions As the Hopkins website eloquently states, "Public health impacts all of us, in every corner of the globe, every day of our livesnot only our health and safety, but also how we live, what we wear, what we eat, what happens to our environment and the stewardship of our planet ... It is because of public health that we have clean water to drink, safe food to eat and are protected from many deadly infectious diseases. This list, an important tool, also reminds us that we have a lot of work to do to address the many challenges that remain."

As we here at the UC Berkeley School of Public Health approach our own milestone anniversary of75 years, we share the vision of improving public health, espe-. dally for the most vulnerable, through continuing research and education in such areas as disease control, aging, maternal and child health, mental health, injury prevention, environmental hazards, and tobacco control.

Which brings us to the last of the Hopkins objects to highlight here: The public health diploma-in recognition of the students at the 59 schools of public health and 109 public health programs around the country who will put what they've learned into practice around the world.

It's well worth a visit to the Hopkins website to check out the full list of objects (www.globalhealthnow.org/100-objects). Many will make you think twice about

things in your everyday life that you may take for granted, such as the flush toilet, which has gone a long way in reducing the spread of disease. And some-like horseshoe crabs, glow-in-the-dark watches, and the Monroe calculator-may surprise you.

Healthy blood pressure, healthy brain is and that there are many accessible and effective drugs, treatment of hypertension may prove to be one of the best ways to prevent or delay dementia.}) High blood pressure (hypertension),

especially in middle age, is a major contributor to cognitive decline

and dementia later in life, according to a new Scientific Statement from the American Heart Association, published in the journal Hypertension. Its review of the research explains how hypertension can cause brain diseases such as stroke, vascular cognitive impairment, and dementia (including Alzheimer's disease), and it highlights what is still not completely understood.

Vascular cognitive impairment involves a range of changes in brain function, from mild to severe, caused in part by impaired blood flow to the brain. The brain and its blood vessels are main targets for hypertension's adverse effects, including oxidative stress, damage to white matter, brain atrophy, and strokes (microscopic or fullblown). Strokes, in turn, increase the risk of cognitive impairment and dementia.

"Hypertension is the most powerful modifiable risk factor for the cerebrovascular damage, and the dramatic reduction in stroke mortality over the past several decades has been attributed to the treatment of hypertension," according to the authors. But while many clinical trials have shown that treatment of hypertension (usually with drugs) reduces the risk of strokes and other cardiovascular disease, the evidence supporting its beneficial effect on cognitive health has been largely observational and has not been able to prove cause and effect. One complication is that it can take decades for hypertension to cause cognitive problems, and clinical trials lasting that long are a difficult undertaking.

The following questions remain unanswered: When is the optimal time to begin treating rising blood pressure in order to protect cognition (perhaps while it's still in the prehypertension range) and how aggressive should the treatment be? When people have both hypertension and advanced cognitive impairment, will treating the former reverse the latter or at least slow its progression? How does hypertension interact with various genetic and neurodegenerative factors in the brain? Do specific classes of antihypertensive dmgs confer greater cognitive benefits than others?

It's hoped that results from the important NIH -sponsored SPRINT-MIND clinical trial, expected later in 2017, will fill some of the knowledge gaps concerning treatment of hypertension as a way to protect cognition. \<Ve'll keep you informed about its findings.

''Although robust evidence is lacking to prove that antihypertensive therapy in middle age provides a cognitive benefit, such a benefit appears likely," the authors stated. ccGiven how prevalent hypertension

Snake in the GRAS? If you're a careful shopper like me, you read

· food labels, including Ingredients lists. If so, you may assume that all ingredients have been approved by the FDA (or some other federal agency) after being assessed for safety. Not so. Most food ingredients have not undergone FDA review, thanks to a law

that allows Ingredients to be considered"generaliy recognized as safe;' or GRAS, without testing or evaluation. Ws a confusing and muchcriticized system that niakes many people, including me, worry about the untested ingredients In processed foods.

GRAS regulations were part of the Federal Food, Drug, and Cosmetic Act as amended by Congress In 1958. This law set up a two-tiered system. For new 11food additives; companies have to get pre-marketing approval from the FDA, based on safety data they submit. But there was an exemption for GRAS ingredients. The Idea was that hundreds of common substances-such as vinegar, baking soda, and caffeinethat had long been In use and were assumed to be safe, would be exempted from the approval process and put on the GRAS list.

In 1997 the FDA added a provisional rule that made the GRAS regulations even laxer. it allowed food companies on their own to decide If additional ingredients are GRAS, based on a safety review by"quali· fied experts" they themselves choose (this Is called "self-affirmed" GRAS status). Companies don't even have to notify the FDA about their new GRAS Ingredients, let alone submit safety data-FDA notifi· cation is voluntary. Under this GRAS loophole, more than a thousand substances have been added to the food supply, with little or no federal oversight. Many of them don't show up on Ingredients lists, hid·

den under the phraseunatural and artificial flavoring,~~ for example. For years, nonprofit watchdog groups such as Consumers Union,

the Center for Science in the Public Interest (CSPI), and the Environ· · mental Working Group have lobbied the FDA to toughen the 1997 interim rule in ways to ensure food safety. It took almost 20 years, but last August the FDA, undoubtedly under pressure from the food In· dustry, finalized the rule with little improvement. Yes, the fox has been left guarding the henhouse.

The laxity and vagueness of the GRAS regulations are troubling. For Instance, what exactly do"reasonable certainty; "adequately shown," and even "safe" mean? Who are these "qualified experts" selected by food companies to assess the safety of GRAS ingredients? To no one's great surprise, many of these experts have industry ties. A study in lAMA Internal Medicine in 2013looked at the expert panels behind 451 GRAS notifications voluntarily submitted to the FDA. It found that "financial conflicts of interest were ubiquitous" and that"the lack of independent review in GRAS determinations raises concerns about the Integrity of the process and whether it ensures the safety of the food supply~

In rare cases, when the health risks of a GRAS ingredient become clear, the FDA can remove Its GRAS status. That happened with par· tially hydrogenated vegetable oils (because they supply trans fat) and cyclamate (an artificial sweetener that caused cancer in lab animals}. Similarly, CSPI has called on the FDA to revoke the GRAS status of sodium so that it can be more strictly regulated and reduced.

It would make much more sense to evaluate the safety of food Ingredients-especially new ones-openly, independently, and systematically, rather than making us a nation of guinea pigs. Unfortunately, the FDA has passed up the opportunity to strengthen the GRAS regulations. All the more reason to limit your Intake of processed foods and, when you do eat them, to choose ones with shorter lists of ingredients.

BerkeleyWellness.com January2017 3

An invisible threat

Carbon monoxide is one of the leading causes of accidental poison

related death in the U.S., killing more than 400 people a year and sending at least 50,000

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greatly decreasing its oxygencarrying capacity. This can trigger symptoms including shortness of breath, nausea, dizziness, lightheadedness, and headaches. The signs and

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to the emergency room, according to the CDC. (That doesn't include the many deaths from carbon monoxide that are suicides.) The risk rises during the fall and winter months, when people fire up their furnaces, as well as after natural disasters, when power outages may necessitate the use of portable generators.

What is carbon monoxide? This colorless, odorless gas is a by-product of combustion, from burning fuel such as oil, gas, propane, wood, and charcoal. Cars, trucks, gas or charcoal grills, gas-powered tools, gas ranges, gas-powered generators, heating systems, fireplaces, and wood-burning stoves all produce carbon monoxide. The gas becomes dangerous when it builds up in enclosed spaces, such as a house, garage, car, boat, or RV, due to inadequate ventilation. For example, heating systems are designed to send fi.rmes outside, but if the systems are not maintained or checked regularly, blockages may occur, sending the fumes back into the building or home. The gas can also accumulate if you burn wood or charcoal indoors or run an engine in the garage with the door closed.

As you breathe in carbon monoxide, it starts to bind to hemoglobin in the blood,

symptoms can be subde and mimic those of other illnesses. If you are sleeping or have been drinking alcohol heavily, you could die of carbon monoxide poisoning without ever noticing the symptoms.

The key is prevention Ill Install a carbon monoxide alarm (see

box at right). Ill Make sure appliances are installed

and vented properly. The CDC recommends that a qualified technician service your heating system, water heater, and all gas, oil, or coal-burning appliances once a year.

m Never use a gas oven or range to heat your home.

mUse generators, charcoal grills, camp stoves, and other gas or charcoal-burning devices outside only, at least 20 feet from windows, doors, and vents.

mil Never leave your car's motor running when it is in the garage, even with the garage door open. The odorless fumes can quickly fill the garage and seep into the attached house. When warming up the car outdoors, make sure the exhaust pipe is not blocked by snow.

If you suspect carbon monoxide poisoning: Get fresh air immediately by going

Golden years

Two studies published over the past year offer insights into the potential health effects of retirement:

Ell Retirement can "provide a window of opportunity for positive behavioral changes," according to an Australian study in the journal of Preventive Medicine. It involved more than 27,000 people (ages 45 and older), 3,100 of whom retired over the study's three-year period. The retirees reported increased physical activity, decreased sedentary time, and slightly more sleep. Among women, the odds of continuing to

smoke were also reduced. Previous research suggests, however, that such changes may depend on a retiree's circumstances and the type of job previously held. For instance, people who have to retire because of illness or injury or to take care of a family member may be less likely to make beneficial lifestyle changes. And some people with physically demanding jobs may end up being less active in retirement.

1!1 Taking part in social groups after retirement is linked to longer life, according to an English study in BM] Open. Re-

4 January 2011 University of California, BerkeleyWellness Letter

outdoors or to a well-ventilated area. Then call 911. It's important that your level of exposure be quickly assessed and that you receive the appropriate treatment right away at a hospital emergency department.

Every home should have carbon monoxide alarms (in some states and localities, · this Is mandatory). These potentially lifesaving devices usually cost less than $50 and are relatively easy to install.

There are two main types: batterypowered and those connected to a home's electrical system. Battery-powered units will work during_ a power outage, but you must remember to change the batteries ,every six months. (A good, way to remember: Do ,i.t when yOU. change your clocks each spring and fall.) Alarms that run on a home's electricity can either plug into existing power outlets or be hard-wired into the electrical system by an electrician; both kinds come with a battery backup in case the power goes out.

Whichever type you choose, make sure it meets Standard UL 2034 of the Underwiiters Laboratory. The labei will have this information. tallow the manuf~cturer's Installation Instructions, which include not placing them near heat or combustion sources-an_d replace them every five years. If one.star.ts rioging, go outside and call 911 immediately (some battery-operated alarms begin to chirp to alert you If the power is low1 but continuous ringing from a properly installed device indicates an unsafe level of carbon monoxide).

searchers followed 424 people during the six years after they retired and found that the more memberships to clubs, organizations, or societies they maintained, the better their quality of life and the less likely they were to die (age, health, and other factors were controlled for). Vigorous exercise was also associated with lower death rates; conversely, giving up exercise after retirement was linked to higher death rates. This suggests that "group memberships have a distinct role to play in the process of adapting to new circumstances following retirement [and have] effects that are comparable in size to those of physical activity," the researchers concluded.

X-rated restaurant meals mozzarella appetizer with all the calories you need for the entire day. A fried chicken meal with four days'

worth of saturated fat. A spinach-artichoke dip with a two-day supply of sodium. A slushy drink with more than a cup of sugar (that was not a typo). These are just a few of the startling standouts in the latest 'Xtreme Eating Awards," presented every year by the nonprofit Center for Science in the Public Interest (CSPI) to highlight the unhealthiest chain restaurant meals in America.

Nine menu items made the 2016list, coming from such nationwide chains as Applebee's, The Cheesecake Factory, Dave & Buster's, Sonic, Uno Pizzerla & Grill, Maggiano's Little Italy, and Buffalo Wild Wings. Here are some of the "winners," listed in order of calories from hugest to merely huge. But first, to put the numbers into perspective: Food labels are based on a 2,000 calorie-a-day diet (though people's calorie needs vary depending on their body weight, activity level, and other individual factors). For that calorie level, the 2015-2020 Dietary Guidelines for Americans recommend no more than 20 grams of saturated fat and 48 grams of added sugar (12 teaspoons) a day-and no more than 2,300 milligrams of sodium for the general population.

II Whole Hog Burger at Uno Pizzeria & Grill-made, literally, with the "whole hog" including sausage, bacon, prosciutto: 2,850 calories, 62 grams of saturated fat, and 9,790 milligrams of sodium.

Ill Fried Chicken & Waffies Benedict at The Cheesecake Factory-as if each of these alone was not enough for a mealplus it comes with fried eggs and usually a side of potatoes: 2,580 calories, 86 grams of saturated fat, 3,390 milligrams of sodium, and 60 teaspoons of sugar (thanks largely to the maple-butter syrup included).

Ill Dessert Nachos at Buffalo Wild vVings-a flour tortilla (fried in beef tallow) and ice cream, topped with caramel and chocolate sauce and cheesecake bits: 2,100 calories, 64 grams of saturated fat, 5 grams of trans fat, and 120 grams of sugar.

m Short Rib & Cheesy Mac Stack at Dave & Buster's~served as a sandwich and with potato tots: 1,910 calories, 42 grams of saturated fat, and 3,390 milligrams of sodium. Busted!

l!l Cremini Pork Shank at Romano's Macaroni Grill-weighing in at 2 pounds: 1,800 calories, 43 grams of saturated fat, and 3,700 milligrams of sodium.

Ill RT 44 Grape Slush with Rainbow Candy at Sonic-a 44-ounce concoction of what CSPI calls "sippable candy": 970

Fitness trackers: a flop?

If you need to lose weight, a wearable fitness tracker may seem like a good helper. But such a device was actually

found to be less effective than standard behavioral methods in promoting and maintaining long-term weight loss, in a recent study in the journal of the American Medica/Association.

The two-year study involved 471 overweight or obese adults, ages 18 to 35. For the first six months, all participants received a low-calorie diet plan and were instmcted to do 100 minutes of moderate activity per week and gradually increase this to 300 minutes per week. They also took part in weekly group counseling sessions.

Mter six months, the participants were split into two groups. One group was in-

structed to start tracking their diet and physical activity using a website (standard intervention). The other group received fitness trackers-devices worn around the upper arm that tracked their physical activity all day; web-based software allowed for monitoring of dietary intake. The two groups were then weighed every six months.

The researchers hypothesized that those who wore the trackers would lose more weight, but the opposite happened. The greatest weight loss-about 18 pounds in both groups-occurred during the first six months, before the groups were split up and half started wearing the trackers. vVeight was regained at every subsequent six-month reading, but more rapidly among those using the fitness trackers. Mter two

calories, virtually all from sugar. "Far from doing their part to reverse the

obesity epidemic, America's chain restaurants are pouring gasoline on the fire, crossing fried chicken and waffles with Eggs Benedict, merging cheeseburgers and egg rolls, and repurposing macaroni and cheese as a sandwich filling," CSPI cautioned.

Words to the wise You don't have to bypass chain restaurants altogether, but if you do pull up to one on occasion, here's how to keep things under control: Pay attention to nutrition information (which, under the Affordable Care Act, is now required to be provided by chain restaurants); order the smallest size (who needs a 44-ounce drink?); skip anything that's "stacked," "stuffed," or "toppedu (or just combines too many disparate and unhealthy food items); ask your server to hold the fries, onion rings, rolls, or other extras that may be included in the meal (which can add hundreds more calories); skip indulgent desserts (or at least share them); and take half(or more) of your meal home to eat later.

Some restaurants offer "light" menusthough that may not mean the offerings are low in calories (one chain's "Lighter Take" dishes have 800 to 1,000 calories). And if. you happen to still overindulge, make up for the calories by eating lighter the rest of the day-or perhaps the rest of the week.

years, the fitness trackers group had lost an average of 8 pounds, compared with 13 pounds in the self-monitoring group.

Despite getting ongoing feedback on their calorie burning from their devices throughout the day, the tracker group got no more exercise on average than the group that didn't wear trackers. And there were no significant differences between the groups in body mass index, fat mass, and cardiorespiratory fitness.

''Although this study showed weight loss across the 24-month intervention in young adults, similar to trials of middleaged and older-aged adults, the benefits achieved at six months were not fully sustained long term," the researchers noted. "Thus, regardless of age, challenges remain to preventing or minimizing weight regain following initial weight loss in adults."

---···--·-·---BerkeleyWellness.com January2017 5

Spinning: for body-and soul? For the past few years, one of the biggest

trends in fitness training has been spinningthat is, group stationary cycling done very ener-

getically in a health club or special studio with an instructor leading the workout. {"Spinning," with a capital

S, is actually a trademarked name for one type of indoor cycling and one brand of stationary bike, but"spinning"is increasingly used for all sorts of high-intensity cycling clas$es.) While there's no doubt that such cycling sessions can provide a very intense cardiovascular workout, there's plenty of debate about the effectiveness and safety of specific programs. One of the most popular companies, SouiCyde, has elicited some of the strongest criticism for its workouts.

Spinning attractions While old-fashioned stationary cycling can become boring quickly, spinning classes psych up participants with varied workouts, fasttempo music, motivational coaching, camaraderie, and often visual imagery {sometimes "virtual" outdoor courses, complete with hills and valleys). Workouts typically are 40 to 60 minutes long and can burn 400 to 700 calories. Pedaling gets up to 80 to 100 rpms (revolutions per minute) or even faster, sometimes raising heart rate above the standard target range to near-maximum rate, as is done in high-intensity interval training (see tinyurl.com/interva\WL). Like any cycling, spinning can improve muscle endurance in major leg muscles, and like any intense aerobic workout, it can boost exhilaration-inducing endorphins (those brain chemicals largely responsible for"runner's high'). When done correctly, it's a low-impact workout that is easy on hips, knees, and ankles, though that often Isn't true ofSouiCycle.

Adding some soul? Sou!Cycle is a hit in some U.S. cities, where it has a devoted (some say almost cult) following and the usual celebrity endorsements. It features crowded, steamy, atmospherically lit rooms, pounding dance music, and high-energy leaders {combination fitness trainer, inspirational guru, disk jockey, and cheerleader). What also sets SouiCycle apart is that it melds group cycling with aerobic dance, adding in light hand weights, upper-body workouts (such as abdominal crunches and twisting), standing up on the pedals while cycling at high speed with little or no resistance, and push-ups on the handlebars while cycling (yes, you read that right).

Numerous exercise physiologists and other experts have given SouiCycle failing grades, warning about the risk of injury from many of its maneuvers. They also point out that such multitasking-that is, addIng in all these extraneous moves-can undermine the basic cycling workout, with little added benefit. If you wantto build muscle, you'll still need to do regular weight training or calisthenics.

Pedaling backwards? Another controversial maneuver in some spinning classes Is pedaling backwards, which is supposed to be a form of cross-training. A study by the American Council on Exercise (ACE), published In ACE ProSource In 2015, found that this may boost calorie burning and heart rate a little more than forward pedaling and that it better targets the quadriceps muscles (on the front of the thighs). For many people, however, backward pedaling is difficult and can put excessive stress on knees and ankles. We recommend against it, especially at high intensity.

With benefits come rlsi<S Spinning may be too challenging for people who are unfit or have knee, hip, or other injuries or blomechanlcal problems. If you don't already do intense cardia exercise or If you have heart disease or another medical condition and are considering taking a spinning class (or doing other intense workouts), consult your health care provider

6 January 2017 University of California, BerkeleyWellness Letter

first. If you get the go-ahead, start by cycling on your own on a stationary bike, working up to a form of high-Intensity interval training. Some facilities offers classes for beginners.

Though there have been reports of injuries or other adverse events from spinning (including severe muscle damage and ankle fractures), for most people, spinning Is safe

when done correctly. That means good posture, proper seat and handlebar position, and no calisthenics or hand weights (sorry, SouiCycle).

ACE recommends: Ask about the instructor's training (preferably with certification from an organization such as Mad Dogg Athletics, Schwinn, Reebok, or ACE); bring a full water bottle; make sure the seat is at the right height; and cycle at your own pace when you need to.

If you are a beginner, the Instructor should be willing to give some individual guidance before (come early} or after class and should encourage you to monitor your level of exertion, either by checking your heart rate or using perceived exertion (see tinyurl.com/targetheartWL).

No matter how hard the instructor pushes the class, listen to your_ body and don't be afraid to slow down or take a break (don't worry what your classmates may think). Avoid classes that call for excess.ive upper body movement (such as push-ups), pedaling backwards, and over-the-top intensity (more than 110 rpm)-or at least skip those moves. And don't get too caught up in the competitive nature of spinning. Your body-and soul-will thank you.

Tips from a spinning instructor The following pointers come from Barbara Van Tine, who is a certified spinning instructor and a contributing editor to the Welfness Letter.

il Spinning is a great class (when taught properly) for people of all ages and fitness levels. Most people in my classes are baby boomers, but they range in age from 16 to 89. One nice thing about it is that you can control your own intensity. I have some older participants who are former runners whose doctors told them that their joints could no longer take the pounding-spinning is perfect for them.

'f.1 Beginners, in particular, may want to look for classes that use bikes with power meters, which can help them know when they're working too hard (or not hard enough). Most clubs have them now, and the meters have more or less replaced heart monitors because they more accurately Indicate a rider's power output. Safe rpms are 50 (uphill) to about 110 (short sprints).

ill Not all spinning classes are the same. My first concerns are safety, proper technique, and bike setup. There are a lot of rogue, uncertified instructors out there, who push people harder than necessary and do lots of crazy moves. I recently took someone else's class at my gym and it was mostly made up of wild, unsafe moves. If you take a class and it seems too Intense, try out different Instructors. You may need to shop around to find what works best for you.

1111 wouldn't advise Investing in special bike shorts or clip-in bike shoes, at least not initially. Take a few classes first, and only if and when you feel that the accessories may help should you buy them. Cross-trainers are fine; running shoes shouldn,t be used because they don't have lateral support.

r>l Participants should never pedal backwards, no matter how well trained they are. Rule of thumb: If you wouldn't do it on a bike outside, you shouldn't do it indoors, either. And the music shouldn't destroy your eardrums.

NI Another benefit is the socialization: People in a spinning class often end up being a very tight-knit, friendly group.

Q I often get red, itchy, swollen eyelids, What can I do to relieve this?

A This sounds like blepharitis, though if symptoms last more thim two weeks or are particularly bothersome, you should see an eye doctor for evaluation. If It is blepharitis, you may also experience crusting around the eyelashes, excessive tearing of th.e eyes, and a burning sensation.

Blepharitis can affect the frontof the eyelid, where the eyelashes are attached. The two most common causes of this are bacteria and seborrheic dermatitis (like scalp dandruff but on the eyelids). It can also affect the inner eyelid when the oil (meibomian) glands located around the base of the lashes become clogged and accumulate debris. Blepharitis is also frequently associated with acne rosacea (which causes red and inflamed skin) and dry eye syndrome. Some people develop hordeola (painful lumps near or on the edge of the eyelid, commonly known as styes) in conjunction with blepharitis.

Though blepharitis can clear up on its own, it often becomes a chronic condition that requires daily care for life. However, while it may be uncomfortable, it rarely has serious medical consequences and is not contagious.

Home treatment involves keeping the lids clean and free of crusts. Using a dean washcloth, place compresses soaked In warm water over your eyes for several min· utes, several times a day, to loosen the crusts. Then lightly scrub the eyelids using a mixture of water and a few drops of baby shampoo placed on a cloth or cotton swab. Commercial eyelid scrubs are also available. Follow with a lid massage, using either a washcloth or a clean fingertip: Gently mas· sage your lids using circular motions to dear the all accumulated in the glands.

Don't wear eye makeup or contact lenses until the symptoms clear. If scalp dandruff is present, a dandruff shampoo for the hair Is recommended as well to prevent the debris from falling into the eyes and causing a further reaction and clogging of the glands.

If self·care measures don't help enough, your doctor may prescribe antibiotics or steroid eye drops. Topical antibiotic ointments can be applied on the eyelid edges for a few weeks. Oral antibiotics may be needed for more difficult-to·manage cases, such as in people with rosacea.

Q Are Canadian bacon and turkey bacon healthier choices than regular bacon?

A They have significantly fewer calories and less fat than regular bacon. But they're not better in all ways-which Is why you should limit how much you eat of any type of bacon.

American-style bacon Is made from pork belly meat and is highest in calories (120 to 150), fat (10 to 12 grams, much of which is saturated), and sodium (300 to 600 milligrams} per ounce, uncooked. Keep in mind that bacon varies widely in terms of calories, fat, and sodium1 depending on the brand, cut of meat, 'and how it is prepared. When bacon is heated, a fair amount of Its fat cooks off, so that a well-cooked strip may have only half the calories of an uncooked slice, assuming the grease Is not consumed.

In contrast, Canadian bacon-also known as English, Irish, or back or pea meal baconis typically made from leaner pork loin and Is more like ham, with about 30 calories, less than 1 gram of fat, and about 200 milligrams of sodium per ounce, uncooked.

Turkey bacon, which is made from ground dark and light turkey meat, may

sound like it would be healthier than any type of pork bacon-but it has more calories (65 per ounce) and fat (5 grams) than Canadian bacon and is also high in sodium (300 milligrams). Still, it's a better choice than regular bacon.

To lower the fat and calories, cook bacon on a grill (Indoor or outdoor) or on a rack in a pan in the oven, which allows the fat to drip off. Don't pan-fry it or add more fat or oil in cooking. For further reductions, blot the bacon on a paper towel after cooking.

Another issue with all cured bacon is that such processed meats were classified by the International Agency for Research on Cancer In 2015 as"carclnogenic to humans,"based on observational studies linking them to colorectal and other cancers-possibly due to their nitrate and nitrite preservatives. Though it has not been clearly established that processed meats cause cancer {observa~ tiona! studies do not prove cause and effect), It's still a good idea to limit them, since there's strong evidence linking them to cardiovascular disease and other disorders.

What about veggie 11bacon"? Typically made from textured vegetable protein and wheat gluten (along with a long list of additives), these highly processed products can be just as high in calories and sodium as reg· ular bacon (and lower In protein). One brand has 1 OS calories, 8 grams of fat, and 200 mil- · llgrams of sodium per ounce (about 4 slices). Though much of the fat comes from healthier vegetable fat, go easy on this bacon, too.

If you have a question you would like to see answered In tho Wei/ness Letter, email us at [email protected]. Or write to UC Berkeley Wellness Letter, Ask the Experts, Berkeley CA 94720-7360. We regret that we are unable to publish answers to all questions or respond to all letters personally,

Editorial Board University of California, Borkeloy

CHAIR Stefano Berloui, M.D, Pb.O~ Dean, School of Pubf.e Heaflh Mallon Maus, M.D., Dr.P.H., FAC.S., Adjunct Pwfessor, Pl,lb!lc Health John Edward Swarbblllg. M.D., F.A.C.P. Edward R. Bloru, Ph.D., Assistant Cffnlcal Professor, C!inlcal Pharmacy, UCSF Guy MiO(;o, M.D.,. Pwfessor &Mritus, UCB/UCSFJo1nt Madkal Program Professor Emeritus, Health and Medical Sclances Cindy J, Chang. M.D., Associate Clinical Professor; Sports Medicine, UCSF James P. Seward, M.Dq M.P.Pq Cl!nlcal Professor, Pub fie Health ASSOCIATE CHAIRS · LllyChaput,.M.D., M.P.H.., UC Davis Medical Center KirkR.Smith, Ph.D.,. Professor,Erwironmental Health Joyce C.lashol, M.D., Professor Emerita, Pubrc Hearth Teh-wai Hu, Ph.D., P10fesscr Emeritus, Health Economks Laura E. Stachel, M.D., M.P.H.,. Obstetrics and Gyne cc1ogy William A. Perella, M.O., M.P,H., Occupational and Steven Jacabsobn, M.D., Clinical Profasscr, Gastroenterology, UCSF S. Leonard Syrne, PILD.,. Professor Emeritus, Epidemloklgy Environmental Medicine Ronald M. Krauss, M.O.,.Adjunct Professor, Nutritional Sdences Oale A. Ogar, Managing Editor'

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BerkeleyWellness.com January2017 7

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vVellness Made Easy--r.t Trying to lose weight? Making lunch your main meal may help more than eating the most calories at dinner, suggests an Iranian study recently in the American journal of Clinical Nutrition. Sixty-nine healthy overweight or moderately obese women took part in a sensible clinic-based weight-loss program; half were told to make lunch their biggest meal, the other half dinner. They chose their own food but got guidance from nutritionists and were encouraged to exercise. Though there were no signilicant differences in their calorie or macronutrient intakes, after 12 weeks the lunch group lost 3 pounds more, on average, than the dinner group (9~ vs. 12lh pounds) and had a greater improvement in insulin sensitivity. Longer-term research is needed to determine if these results can be maintained and generalized,

[_t If you take medication for osteoporosis, It's still important to maintain bonehealthy lifes\Yie habits. While such dmgs decrease fractures, they do not eliminate all risk, as was reported in a study in the journal Bone of more than 7,400 women, ages 50 and older, who were On oral bisphosphonates {the most common osteoporosis treatment) for at least two years. Despite treatment, about one-third remained at elevated risk for future osteoporotic fractures because their bone density didn't improve-or even worsened-or they had suffered fractures while taking the drugs. Lifestyle measures include not smoking, doing weightbearing exercise,getting recommended amounts of calcium (1,200 milligrams a day for women over 50 and men over 65) and vitamin D (600 to 800 IU a day, though many experts recommend 800 to 1,000 IU or more), and taking steps to decrease falls, such as removing obstacles and improving lighting at home and using canes or other assistive devices when needed.

[i{ To avoid slipping on Icy or otherwise slick streets, try adapting a new walking galt: Bend slightly at the waist so that your center of gravity falls over your feet, and slowly take short, flat-footed steps-in effect, shuffling a little like a penguin. Keep your arms free for balance-you can even extend them out to the sides as you walk for more steadiness. 'Near gloves so you are less inclined to put your hands in your pockets-that way your hands and forearms will be free to help break a fall, if necessary. And wear shoes that have good traction, not slippery soles. Be aware that you can't always see ice on streets or roads (what's called "black ice'' or "clear ice"); rather, the surface may simply look wet or black.

[i{ Ever wonder why tomatoes stored In the refrigerator lack flavor? A new study in the journal PNAS found that keeping tomatoes below 53 oF (12T) reduced the expression of several genes involved in the synthesis of flavor-imparting volatile compounds, resulting in insipid fruits. The researchers refrigerated heirloom and modern varieties of ripe red tomatoes for one to seven days. The longer the refrigeration, the greater the loss of volatile compounds. After seven days of cold, the compounds were reduced by nearly two-thirds; subsequent storage at room temperature didn't restore the compounds to normal levels. A panel of consumers judged the previously refrigerated tomatoes (after a day at room temperature) to be much less flavorful than fresh nonrefrigerated fruits. The tomatoes' sugar and acid content, however, remained largely unchanged by refrigeration.

[i{ If you have asthma, a vitamin D supplement, taken along with standard medication, may help prevent attacks, according to a new Cochrane review, which looked at nine clinical trials involving children or adults, most with mild to moderate disease. It found not only that people who took the supplements had fewer asthma attacks than those taking a placebo, but also that they were one-third less likely to have an attack requiring steroid medication, and two-thirds less likely to have an attack requiring a trip to the hospital. However, vitamin D was not associated with improved lung function or day-to-day symptoms. It's not known what dose is optimal (dosage ranged from 400 to 4,000 IU a day, or 60,000 IU a month, in the studies) nor how baseline vitamin D status affected the results.lVIoreover, the benefits were seen mainly in adults, so more research is needed, particularly involving children with asthma.

January 2017 University of California, Berkeley Wellness Letter

Silly science? Every so often (actually quite often), we come across studies that don't deliver lifesaving news but nevertheless provide insights that may motivate people to change some behav~ iors or thought patterns in positive ways. Here are three recent quirky examples.

1!1 Eating more fruits and vegetables may make you happier1 according to a study in the American Journal of Public Health, which included more than 12,000 Australians of all ages. Life satisfaction and happiness increased in~

crementally with each daily serving of produce, with the greatest jump (from less than one portion a day to more than eight) equal to the gain In mental well-being that comes from moving from unemployed to employed status. "These findings are consistent with the idea that eating certain foods is a form of investment in future happiness and well-being; with the psychological benefits occurring much more quickly than the physical health benefits. Though it's not clear why, some "intriguing possibilities" are that fruits and vegetables Increase serotonin levels and change brain chemistry through their effects on microbes In the intestines.

!!l Telling yourself you can do better can really help you do better on cognitive tasks, suggested a British study in Frontiers in Psychology that involved more than 44,000 participants in an online program. Researchers tested psychological skills across different aspects of a task, and found that performance improved most when people used self-talk (for example, they told themselves they could beat their best outcome). Another technique, imagery, was also effective in some situations (they pictured themselves reacting more quickly, for example). Of course, nothing beats studying and preparation.

ll Exercising four hours after learning something may help you remember it better, reported a Dutch study In Current Biology, in which 72 people studied picture-location associations and then did 35 minutes of interval training immediately after or four hours afteror did no exercise at all. Two days later, those in the delayed-exercise group remembered more of the associations on a recall test than the Jmmediate~exercise and no-exercise groups. Exercise triggers the release of brain chemicals that may promote memory consolidation, but the study did not determine the optimal time window (waiting a longer or shorter time before exercising might improve results as much or even more) and whether the effect varies depending on the type of memory task.

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