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From YouTube: Dearborn Heights Study Session: 3/2/21
Description
The Dearborn Heights Study Session of the Healthcare Presentation taking place Tuesday, March 2nd 2021 via Zoom.
A
B
B
So
the
request
was
that
this
was
going
to
be
presented
what
it
is
to
be
self-insured
what
our
total
costs
are
for
both
active
and
retired
personnel,
and
so
that's
what
tonight's
presentation
is
about,
and
so
with
that
I
will
have
jonathan
prevent
present
his
the
slides
that
we
discussed
and
if
there's
any
questions
after
we
can
certainly
address
those.
In
addition,
if
there's
an
additional
presentation
that
we
need
to
do,
if
we
need
to
drill
down,
we
can
address
that
at
that
time.
Okay,.
D
D
Some
of
the
cost
information
may
look
funny,
so
we
want
to
make
sure
that
we're
we're
framing
that
and
then
we'll
also
answer
questions
about
the
the
self-insured
costs.
The
fully
insured
costs
of
for
the
city
and
then
we're
gonna,
then
summarize,
total
cost,
so
the
cost
the
cost
section.
What
we're
going
to
see
is
a
lot
of
it
is
similar
information.
D
D
So
the
first,
the
first
thing
we're
going
to
talk
about
is
a
self-insured
primer.
So
this
is.
This
is
just
to
go
over
what
it
means
to
be
self-insured,
so
in
in
the
insurance
space.
There's
really
two
type
of
financing
arrangements
for
welfare
plans
and
welfare
plans
are
things
like
medical
prescription,
drug
dental
vision
and
those
two
financing
arrangements
are
fully
insured
and
self-insured.
D
D
So
if
somebody
goes
to
the
pharmacy
and
fills
a
script
for
a
250
dollar
medication
that
250
dollars
less,
whatever
the
the
person
pays
and
co-pays
becomes
the
financial
responsibility
of
the
plan
or
of
the
employer
and
the
reason
we'll
get
into
some
of
the
reasons
behind
that.
But
self-insurance
is
the
funding
arrangement
that
is
favored
by
a
majority
of
larger
employers
and
that's
both
in
the
public
and
private
space.
D
Part
of
the
reason
for
that
is,
as
we
we're
all
hearing
about
it
almost
constantly
in
the
news
about
the
the
way
that
health
care
costs
continue
to
go
up
and
up
and
up
self-insurance
is
one
of
those
strategies
to
better
help.
Control
costs
over
time.
Okay
and
I'll
point
this
back
out
towards
the
end
of
the
meeting,
and
I
want
to
when
we
get
into
the
costs,
I'm
going
to
bring
you
back
to
this
concept
and
I'll
show
you
why
why
the
city
has
benefited
from
being
self-insured?
D
D
For
larger
employers,
like
the
city
costs,
costs
are
always
driven,
regardless
of
whether
you're,
fully
insured
or
self-insured
costs
are
always
driven
by
how
people
utilize
the
benefits.
Okay,
the
more
benefits
people
utilize,
the
higher
your
costs
are.
Okay,
the
only
difference
between
self-insured
and
fully
insured
is
when
those
costs
are
realized.
D
What's
going
to
happen
is
if
you
are
fully
insured,
the
insurance
company
is
just
going
to
ask
for
a
much
bigger
increase
at
renewal.
Okay,
so
you
may
not
recognize
those
costs
now
you're
going
to
recognize
those
costs
later
and
then
in
a
self-insured
arrangement.
It's
the
opposite,
you're,
really
recognizing
those
costs,
as
you
go
as
opposed
to
seeing
those
caught
the
cost
impact
at
your
renewal.
D
Also
self-insured
arrangements
allow
employers
to
avoid
some
of
the
extra
expenses
that
you
might
otherwise
see
in
a
fully
insured
arrangement.
Things
like
premium
taxes,
risk
retention,
that's
a
fancy!
That's
a
fancy
word
for
the
fact
that
insurance
companies,
even
though
they're
in
the
risk
business
they
tend
not
to
like
to
take
risk
because
they
want
to
be
profitable.
Okay,
so
they
charge
retention
of
charges
to
pad
their
pad
their
risk
position
and
then
there's
state
mandates.
D
So
the
next
page
is
a
schematic
of
how
insurance
companies
and
insurance
plans
are
constructed
in
the
medical
and
prescription
space.
Okay
and
some
of
these
concepts
apply
to
the
to
the
dental
and
optical
as
well,
but
really
in
a
in
an
insurance
plan.
There
is
a
claims
payer,
there's
an
entity
paying
claims.
Okay,
so
that's
gonna,
be
blue
cross
blue
shield
of
michigan
health
alliance
plan,
somebody,
that's
getting
the
claims
from
the
doctors
in
the
hospitals
and
then
adjudicating
those
claims.
D
Accordingly,
then
there
is
a
pharmacy
benefit
manager
or
a
pbm.
That's
a
term
again,
if
you've
probably
been
hearing
a
lot
in
the
news.
Recently,
the
pbms
get
a
lot
of
bad
press
because
of
how
they
they
inflate
costs
and
things
like
that
and
then
there's
the
stop
loss
vendor
and
the
stop-loss
vendor
is,
is
the
insurance
company
that
provides
financial
risk
protection
to
a
self-insured
plan
or
self-insured
employer.
D
A
program
called
fresh
bennies
which
provides
telemedic,
medicine
services
or
virtual
visits
to
folks
and
then
elect
rx,
which
is
a
way
an
optional
program
where
people
can
choose
to
import
medications
from
canada
or
australia
or
other
other
countries.
That
kind
of
follow
our
our
fda
and
then
there's
also
the
network
access.
So
right
now
the
medical
and
prescription
plan
utilizes,
the
blue
cross
blue
shield
national
ppo
network.
So
that's
the
that's.
D
D
So
on
the
pharmacy
side,
while
it
looks
to
be
integrated
with
the
medical
plan,
the
pharmacy
benefit
manager
is
actually
express
scripts.
Okay,
that
is
all
handled
behind
the
scenes
so
to
the
retirees
and
the
employees
of
the
city.
They
may
not
even
know
that
express
scripts
is
the
pharmacy
benefit
manager
because
it
just
looks
like
it's
blue
cross,
but
in
fact
it
actually
is
express
scripts.
Beginning
january
1
of
2022,
that's
going
to
change
to
optum.
D
And
then
the
stop
loss
vendor
again
stop
loss
is
a
form
of
insurance
that
provides
financial
protection
to
the
self-insured
plan.
You
know
in
the
event
you
know
you
hear
about
it
in
the
news
now
somebody
could
have
a
million
dollar
medical
expense
right.
The
city
would
not
want
to
take
on
the
risk
if
one
of
the
employees
or
one
of
the
retirees
had
a
million
dollar
medical
expense
you
wouldn't
want
to
take
on
the
entire
cost,
so
stop
loss
insurance,
effectively,
caps,
the
city's
risk
for
those
large
those
large
claimants.
D
Okay,
we'll
talk
a
little
bit
about
that
as
well.
So
right
now
the
city
pays
an
administration
fee
to
blue
cross
blue
shield
for
all
of
those
different
services
and
that's
a
that's
a
flat
administrative
fee.
Every
year
it
changes.
It
goes
up
somewhere
in
the
neighborhood
of
one
to
three
percent
and
that's
paid,
like
I
said,
to
blue
cross
blue
shield,
and
then
I
mentioned
before
the
stop
loss.
D
Insurance,
stop-loss
insurance
is
also
provided
by
blue
cross
blue
shield
of
michigan
and
right
now
the
city
assumes
the
first
130
000
of
medical
and
prescription
claims
risk
on
any
family
unit.
Okay.
So
if
I'm
an
employee
of
the
city
and
my
family,
all
of
my
family
members,
so
I
have
a
wife
and
two
kids.
If
all
of
our
claims
in
total
surpass
a
hundred
and
thirty
thousand
dollars,
the
city
stops
paying
for
those
claims
and
blue
cross
starts
paying
for
them.
D
The
the
dental
and
the
optical
insurance
don't
have
stop-loss
insurance
and
those
benefits
don't
need
stop-loss
insurance,
because
they're,
relatively
low-cost
and
by
design
the
benefits
have
maximums
included
in
them.
So
you
know
the
dental
insurance
may
only
cover
two
thousand
dollars
a
year
of
claims.
Okay,
so
you
don't
need
to
buy,
stop
loss
insurance
because
you
already
know
what
your
your
risk
threshold
is.
D
D
D
So
the
existing
arrangements
right
now,
so
we
talked
a
little
bit
about
the
self-insured
plan
and
what
that
means.
But
the
city
also
has
a
fully
insured
plan
and
the
fully
insured
plan
is
a
medicare
advantage
plan
for
retirees
eligible
retirees
of
the
city
that
are
medi
that
are
medicare
age,
and
so
that
plan
only
covers
retirees
that
are
enrolled
in
medicare
and
it
covers
both
their
medical
costs
and
their
prescription
drug
costs.
D
D
And
that
is
a
federal
program
that
the
city
wants
to
leverage
as
strongly
as
possible
because
you,
the
city,
wants
to
transfer
as
much
risk
and
as
much
cost
from
itself
over
to
the
feds
in
the
form
of
the
met
in
in
form
of
the
medicare
program?
Okay,
so
the
medicare
advantage
plan
is
a
conduit
to
fully
maximize
the
different
medicare
subsidies
that
are
that
are
available
to
employers
that
offer
benefits
to
seniors.
D
D
D
D
Cost
correct
so
just
to
be
clear:
the
retirees
still
have
medicare,
but
by
being
enrolled
in
a
medicare
advantage
plan
you're
exactly
right.
The
federal
medicare
program
sends
funds
to
blue
cross
blue
shield
to
help
finance
the
costs
of
those
retirees,
and
the
only
thing
the
city
is
paying
for
is
the
supplemental
coverage.
Okay,
so.
E
H
D
Yeah,
the
the
feedback
that
we
get
not
just
from
retirees
from
the
city
but
for
other
clients
that
we
work
with
other
employers
that
have
the
the
feedback
is
very
positive,
and
it
mainly
is
a
result
of
the
fact
that
medicare
can
be
very
confusing
because
there's
part
a
and
part
b
and
part
d.
This
medicare
advantage
plan
rolls
everything
up
for
the
retirees,
so
the
only
thing
they
have
to
know
is
they
have
the
blue
cross
medicare
advantage
plan.
They
don't
have
to
navigate
all
the
different
parts
of
medicare
to
understand
their.
D
E
D
The
the
city,
actually
it's
somewhat
of
a
complicated
arrangement.
The
city
is
on
what's
called
a
quarterly
settlement
process
with
blue
cross.
The
quarterly
settlement
says
blue
cross,
says
city
of
dearborn
heights.
You
give
us
x
amount
of
dollars
every
month
and
that
that
those
dollars
should
cover
all
of
those
claims.
D
Okay,
at
the
end
of
that
quarter,
then
blue
cross
says
you
gave
us.
You
know
x
dollars.
This
is
how
much
we
paid
out
and
either
we're
going
to
give
you
a
refund
or
we're
going
to
charge
you
the
balance.
Okay.
So
so
it's
actually
a
very
simple
banking
transaction
for
the
city.
You,
the
city's,
not
having
to
you,
know,
manage
a
bunch
of
like
unique
payments.
As
you
go,
it's
it's
one
payment
a
month
effectively.
D
E
D
We
would
then
send
that
to
elizabeth
with
an
explanation
of
how
the
costs
are
broken
down
and
confirmation
that
we've
reviewed
it
and
then
I
believe
elizabeth
you
send
that
to
the
comptroller
right
for
the
actual
banking
transactions
right
now.
The
reason
we
review
that
is-
and
it
hasn't
happened
in
a
while,
but
I've
actually
been
working
with
the
city
for
a
number
of
years
now
we
have
found
mistakes
in
that
settlement
process
and
sometimes
significant
mistakes
that
have
been
made
by
blue
cross.
D
D
D
So
the
the
the
terminology
that
you're
hearing
about
in
the
news
a
lot
right
now
is
surprise.
Medical
billing.
The
city
has
a
solution
through
fresh
bennies
to
help
employees
in
the
event
they
ever
have
that
problem.
Pillar
rx
is
another
solution.
That's
actually
brand
new
as
of
january
1st,
and
that's
a
mandatory
program
for
high
cost
specialty
medications.
These
are
the
medications
that
you
always
see
on
tv.
D
So
if
you
ever
wondered
every
medication
you
see
on
tv
probably
has
a
price
tag
of
about
three
thousand
dollars
a
month:
okay,
and
so
that
that's
a
that's
a
very
large
liability
for
the
city.
You
know
so
pillar
rx.
What
that
does?
Is
it
leverages
manufacturers,
assistance
programs
or
patient
assistance
programs
so
that
the
city
doesn't
have
to
pay
the
full
cost
of
the
medication
and
neither
does
the
the
employer,
the
retiree,
so
this
program,
what
they
do
is
they
leverage
the
financial
assistance
programs
through
drug
manufacturers?
D
What
ends
up
happening
is
the
city
pays
less
for
the
drug
and
the
member
ends
up
getting
that
drug
at
no
cost,
so
their
co-pay
is
zero
for
those
meds
and
the
truth
is
you
know,
for
a
drug
that
cost
three
thousand
dollars
collecting
a
ten
dollar
copay
on
a
three
thousand
dollar.
Medication
is
not
that
big,
a
video
and
then
the
last
thing
we've
put
it
in,
but
there
hasn't
been
a.
D
D
D
I
think
one
of
the
things
that's
really
important
for
the
council
to
understand
and
and
the
folks
at
the
city
to
understand
is
that
the
there's
an
element
of
working
with
medicare
retirees
that,
if
you
don't
do
that
right,
it
can
end
up
having
a
significant
impact
on
your
opeb
liabilities.
So
your
actuarial
valuation,
if
you're
not
taking
advantage
of
all
of
those
medicare
subsidies,
what
you
could
end
up
finding
is
you're
inadvertently
increasing
your
your
open
liabilities,
because
the
actuaries
can
only
take
into
consideration
certain
medicare
subsidies.
D
E
D
D
D
So
part
of
the
renewal
process
every
year
that
my
team
performs
on
behalf
of
the
city
is
we
we
do
all
those
calculations,
we
calculate
what
the
rates
are.
We
take
the
hard
caps
and
then
we
figure
out
what
the
payroll
deductions
need
to
be
for
each
of
the
different
medical
plans
that
are
offered
by
the
city
to
employees.
D
They,
even
if
they're
in
a
drop
program,
they
are
still
considered
an
employee
in
the
eyes
of
the
state
for
public
act,
152
and
therefore
they
pay
that
they
pay
the
payroll
deductions
for
the
medical
insurance.
If
they're,
truly
retired,
then
it
then,
whatever
they're,
paying
is
of
you
know,
dependent
on
their
collective
bargaining
agreement
that
they
retired
under
okay.
Okay,
now
there,
if
there
are
some
folks
that
are
in
the
drop
that
have
access
to
a
very
generous
medical
plan,
but
they
also
pay
more
for
it,
because
the
costs
are
higher.
A
A
B
A
B
Officers,
so
it
depends
when
they
enter
the
drop
when
you
know
when
they
would
be
eligible
for
retiree
and
what
their
contract
said
at
the
time
of
their
entering
on
the
drop.
That
is
what
you
know
that
kind
of
drives
the
contribution
rate.
Not
so
it's
not
a
hundred
percent
based
on
the
hard
cap
for
all
people
on
the
drop
yeah.
E
D
Now
the
the
good
news
is
that
when
we
implemented
this
back
in
2018,
we
got
tremendous
engagement
from
employees
at
the
city.
We,
usually
we
don't
see
that
level
of
engagement
a
lot
of
times
in
the
public
sector.
We
offered
what
we
did
in
2018
was
we
offered
a
number
of
new
plans,
because
we
are
introducing
payroll
deductions
that
were
a
lot
higher
than
what
employees
had
traditionally
been
accustomed
to
paying.
A
D
So
we
get,
we
had
tremendous
engagement
and
it
the
the
neat
thing
about.
It
is
if
you
look
at
the
way
that
employees
are
enrolled
in
the
different
medical
plan,
options
that
are
offered
the
distribution
is,
is
really
neat
and-
and
what
I
mean
by
that
is
you
see
people
in
the
different
plans
instead
of
all
enrolled
in
the
same
plan,
and
that
means
we're
achieving
the
objective
of
of
giving
people
a
nice
menu
to
order
off
of
where
people
were
meeting
the
needs
of
people
and
employees
kind
of
in
different
spots
in
their.
D
Life
all
right,
so
I
want
to
be
also
transparent.
With
our
engagement,
you
know:
we've
our
engagement
with
the
city
is
one
that's
founded
on
transparency,
unlike
a
lot
of
insurance
agents,
we
actually
want
you
guys
to
know
how
much
we're
making
frankly,
because
we
feel
that
we
earn
it.
But
the
other
thing
is.
It
allows
us
to
give
the
city
advice
without
question
of
whether
or
not
that
advice
is
being
influenced
by
commissions
or
things
like
that.
D
So,
as
you
can
see
here,
our
total
compensation
for
the
year
is
162
000,
okay,
so
we're
billing
in
2021
our
per
quarter
fees
thousand
four
hundred,
and
that's
that
amounts
to
a
hundred
and
one
thousand
six
hundred
annually.
Okay
note
that
we
actually
reduced
that
quarterly
fee
from
2020,
and
that
is
because
we
saw
a
slight
uptick
in
the
commissions
that
we
were
making
that
blue
cross
pays
and
because
of
that,
we
felt
it
was
fair
to
reduce
the
fees
that
we
were
charging
to
the
city.
D
So
we
get,
we
do
get
paid
a
commission
by
by
blue
cross,
that's
tied
to
the
stop
loss
premium
and
that
stop
loss
or
that
commission
on
the
stop
loss
premium
is
three
and
a
half
percent.
That
is
a
standard
commission
and
the
reason
we
collect.
That
is
because,
even
if
the
city
told
blue
cross,
we
don't
want
to
pay
that
three
and
a
half
percent.
They
would
not
change
your
premium
rate
okay,
so
that
is
just
it's
an
efficient
way
to
compensate
us
without
having
to
compensate
us
directly.
D
The
same
goes
for
the
medicare
advantage
premium.
We
get
paid
a
commission
associated
with
the
medicare
advantage
plan
and
the
total
of
the
commissions
and
what
we're
billing
the
city
direct
amounts
to
about
162
000
a
year.
But
I
also
want
to
make
clear
that
we're
taking
part
of
that
162
000
and
we
are
paying
for
the
city's
benefits
administration
system
called
ebik's
banerjee
and
there's
a
approximately
25
000
fee
that
we
pay
on
behalf
of
the
city.
So
the
city
can
use
that
system
that
web
system.
D
E
H
I
Ahead
dave
jonathan,
I
got
a
question
for
you.
I
know
you
mentioned
blue
cross
and
blue
shield.
Is
there
any
other
options
of
other
health
insurance
companies?
So,
for
example,
just
hypothetically,
I
know
in
wayne
county
it's
much
cheaper
to
get
like
health
choice
or
healthy
choice.
I
think
it's
one
of
those
two
and
I
think
it's
sponsored
if
I'm
not
mistaken
in
some
way
or
another
through
the
county,
is
that
something
that
would
be
an
option
if
it's
the
same
type
of
coverage
or
you
know
pretty
good
coverage
for
the
employees.
D
There
are
a
host
of
other
options:
blue
cross
tends
to
be
the
biggest
player
in
town.
They
also
enjoy
the
most
support
from
the
unions
and
people.
Employees
just
tend
to
be
more
comfortable
with
blue
cross
blue
shield
because
it's
a
known
entity,
but
there
are
many
many
options
that
we
could
consider.
In
fact,
we
just
helped
clinton,
township,
replace
blue
cross
blue
shield,
another
self-insured
employer.
I
So
the
reason-
the
reason
I
ask
jonathan
is
if
our
ultimate
concern
obviously
is
saving
students.
I
do
understand
at
the
same
time,
because
the
balancing
act
too,
you
want
to
make
sure
you
provide
good
coverage
for
the
employees
with
that
being
the
case,
and
maybe
this
is
something
elizabeth
can
answer.
Is
this
basically
is
having
blue
cross
blue
shield,
which,
without
a
doubt,
it's
considered
at
least
conceptually
the
best
out
there?
Is
that
one
of
the
things
that
we
attract
used
to
attract
employees
to
work
for
us
and
therefore
yeah?
B
So
one
of
the
things
that
I
have
to
state
offhand
is:
you
have
existing
contracts
and
collective
bargaining
agreements,
so
you
have
to
have
the
language
right
now:
is
blue
cross
or
equivalent?
That's
what
a
lot
of
them
say.
So
you
have
to
really
look
at
that
equivalency
it
and
when
you
do
something
and
you
offer,
if
you're
going
to
offer
a
secondary
coverage,
you
have
to
see
what
that
actually,
the
impact
is
going
to
do
to
the
entire
group.
You
know
if
you
just
went
to
let's
say
a
half
a
half
arrangement.
B
Hap
is
not
going
to
work
for
your
out-of-state
retirees.
So
how
do
you
address
that?
Because
you
have
legacy
costs
and
you
have
a
promise
based
on
a
contract
and
a
retiree
that
that
retired
in
the
1990s
and
they
enjoyed
this
benefit
and
now
you're
telling
them
they're
going
to
half
and
there
aren't
any
half,
perhaps
not
going
to
be
accepted
in
their
state
that
they
reside.
B
D
D
Every
every
community
is
different,
so
every
time
you
try
and
find
a
a
reference
point
on
case
law
to
make
changes
like,
especially
for
retirees
it
really
gets
into
the
nitty
gritty
and
the
the
very
detailed
language
that
were
that
were
part
of
the
collective
bargaining
agreements
that
those
retirees
retired
under.
So
sometimes
you
find
situation
where,
even
if
you
do
all
the
great
work
up
front
in
the
case
of
genesee
county,
we,
the
circuit
court
judge
issued
an
injunction
about
nine
days
before
the
effective
date
of
the
change.
B
And
we
experienced
that
ourselves
here
in
different
heights
and
things
were
tied
up
and
it
did
delay
things
and
it
delayed
savings
that
we
probably
could
have
enjoyed.
Ultimately,
you
know
we
prevailed,
but
you
know
that
is
a
concern
and
to
address.
One
of
your
other
questions
is:
is
this
something
that
attracts
people
to
come
here?
B
D
Problem
so
one
thing
I
really
I
wanted
to
touch
on
quick
before
we
get
into
the
numbers-
is
the
legacy
arrangement,
so
we
mentioned
january
1
2018,
in
conjunction
with
some
of
the
negotiations
that
that
took
effect
on
that
date.
That
was
also
the
date
that
the
city
arrangement
with
health
alliance
plan
was
terminated.
Okay,
so
what
ended
up
happening
was
the
actives,
through
negotiations
eliminated
health
alliance
plan
as
an
option
this?
This
was
mainly
because.
D
D
D
But
what
you
can
see
here
on
this
first
page
is
the
different
components
of
the
self-insured
plan
from
2016
all
the
way
through
2021
and
the
2021
figures
are
all
projected.
Those
are
all
the
figures
that
that
we
projected
and
provided
to
the
city
associated
with
the
self-insured
medical
and
prescription
drug
plan.
Okay,
so
you
can
see
in
2018.
D
So
if
you
go
from
2017
to
2018
and
you're,
looking
at
the
total
costs,
you
can
see
that
the
total
costs
jump
way
up
and
the
reason
for
that
is
that's
in
2018.
We
got
all
those
health
alliance
plan
members
that
previously
were
on
hap.
They
were
now
all
on
the
they
were
all
on.
The
blue
cross
blue
shield,
self-insured
plan
at
that
point,
but,
as
you
can
see
from
2018
to
2021
health
care
costs,
you
know
other
than
a
small
anomaly
in
2020.
D
The
cost
projections
for
active
employees
by
the
way
this
is
for
active
employees
have
been
fairly
static.
Okay,
this
is
great
news.
You
know
the
market
trend
for
health
care
costs
is
seven
to
ten
percent
a
year.
The
city
of
dearborn
heights
is
not
experiencing
a
seven
to
ten
percent
increase
in
health
care
cost
per
year.
D
You,
the
city,
is
very
much
a
kind
of
an
outlier
in
a
good
way
in
that
regard,
and
a
lot
of
that
has
to
do
with
the
engagement
of
the
employees
back
in
the
middle
of
2017
during
bargaining,
you
got
to
give
credit
where
credit's
due
the
employees
were
very
engaged.
They
made
very
good
decisions
on
how
they're
enrolling
in
plans
and
they're
understanding
their
benefits
better
than
the
average
employee
at
other
communities.
Do.
B
Is
and
dispatch
every
every
group
and
we
engage
them
every
year
we
involve,
we
have
a
kind
of
a
committee
that
we
meet.
You
know
we
did
it
virtually
this
year
and
we
remain
in
contact
and
we
continue
to
educate
and
do
the
best
we
can
and
we
receive
their
feedback
and
we
run
with
it
if
they
have
a
good
idea.
We
run
with
it.
E
H
B
E
D
So
the
next
page
is
the
is
the
dental
and
the
vision
costs
for
active
employees
again
26
2016
through
2021,
you
see
a
again
a
big
jump
in
2018.
That
was
really
more
so
in
terms
of
how
the
costs
were
being
allocated
by
actives
and
retirees.
There
was
a
change
in
in
how
we
were
doing
that
for
dental
and
vision
claims
only
so
that
explains
why
and
you'll
see,
there's
a
corresponding
favorable
adjustment
to
the
retirees
when
we
get
when
we
get
to
their
costs.
D
But
again,
dental
and
vision
costs
tend
not
to
have
big
changes
year
to
year.
Okay,
though,
those
costs
aren't,
don't
experience
the
same
types
of
changes
and
the
reason
for
that
is
they.
You
know
there
aren't
new
glasses
being
invented
like
there
are
new
prescription
drugs
being
invented
right,
you
know,
a
dental
cleaning
is
a
dental
cleaning
other
than
silver
versus
white
fillings.
It
it
there's
not
a
lot
of
advancement
in
the
that
field
like
there
is
in
the
medical
field,
jonathan.
I
D
So
again,
that's
gonna.
That's
gonna
be
more
because
of
how
we
were
allocating
costs
between
actives
and
retirees.
When
we
look
at
total
costs,
you're
gonna
see
that
those
there
wasn't
a
huge
jump
in
in
cost.
This
is
just
active,
so
we're
not
including
the
retirees
in
these
figures
so
and
we'll
get
to
the
we'll
get
to
the
retirees.
I
think
it'll
make
more
sense
when
you
see
that
all
right,
so
the
the
next
page
here
this
is
retirees
and
the
self-insured
plan,
and
it's
the
it's
the
same
story
from
2017
to
2018.
D
You
had
all
those
hap
people
come
in
to
the
plan
in
2018
they
left
hat,
went
into
the
self-insured
plan.
That's
explaining
the
big
cost,
but
again
you
can
even
see
in
2020,
even
though
the
actives
had
an
anomaly
on
the
high
side,
the
retirees
had
an
anomaly
to
the
good
side.
Okay,
so
in
total
costs
have
been
fairly
static.
We
have
projected
a
higher
cost
in
2021.,
a
lot
of
that
has
to
do
with
covid
and
people
that
deferred
medical
care.
D
F
F
D
D
Enrolled
in
the
medicare
plan
so
we'll
get
to
the
medicare
stuff
too:
okay,
okay,
so
councilman
muscat
you've
been
my
my
segway
guy
all
all
evening.
So
if,
if
you
look
here
at
the
next
page,
what
you
have
is
the
medicare
advantage
enrollment
and
costs
over
time.
So
if
you
look
again
well,
we've
had
increasing
numbers
of
retirees.
D
If
you
look
from
2018,
all
the
way
to
2021
and
even
in
2021
blue
cross
came
back
with
a
significant
reduction,
and
this
is
what
I
was
talking
about
earlier.
The
feds
provided
a
deeper
subsidy
associated
with
medicare
advantage
plans,
and
the
city
was
the
immediate
beneficiary
of
that.
If
you
were,
if
you
were
insuring
medicare
retirees
on
a
different
platform,
you
may
not
have
experienced
that
cost
reduction
for
2021.
D
D
D
C
D
So
I'm
gonna,
I'm
gonna,
move
to
the
end,
because
the
the
other
pages
that
we
just
kind
of
skipped
by
were
just
it-
was
just
summing
up
the
prior
pages,
so
it
gave
it
gives
y'all
an
opportunity
to
have
those
numbers
totaled
up
without
having
to
do
the
math
yourself.
But
what
I
really
wanted
to
focus
on
is
the
total
cost.
Okay-
and
this
is
actives
retirees,
medical,
dental,
prescription,
drug,
it's
effectively,
the
city's
entire
welfare
benefit
plan.
D
D
If
you
look
from
2017
to
2018,
total
cost
dropped
by
half
a
million
dollars;
okay,
so
that
worked
out
most
definitely
in
the
city's
favor.
Okay
and
again,
we
have
to
give
credit
to
the
the
labor
groups
because
they
were
instrumental
in
helping
get
there
as
well.
And
if
you
look
from
2018
to
2020
and
remember,
2020
includes
some
projections,
some
very
conservative
projections,
just
in
case
we
see
some
negative
implications
due
to
covid
health
care
costs
have
been
effectively
flat.
D
This
is
it's
unheard
of
like
I
would
love
to
say
that,
like
I
can
pinpoint
exactly
why
costs
have
performed
so
well,
but
I
think
it's
a
combination
of
engagement
from
employees.
Jonathan,
please
not
a
little
bit
of
luck.
There.
You
go
newly
noted.
So
for
the
last
five
years
the
city
has
enjoyed
a
very
favorable
cost
position
on
healthcare,
including
dental
and
vision.
D
So
that
is
my
presentation
as
you,
you
might
be
able
to
tell
I'm
fairly
passionate
about
this
topic.
I'm
happy
to
provide
any
more
data
again,
if,
if
we
can
get
it,
I'm
happy
to
provide
it.
But
I
love
talking
about
this
stuff.
So
if
you
ever,
if
you're
ever
interested,
feel
free
to
contact
me-
and
I
can
answer
any
questions
that
you
might
have.
I
I
But
how
do
we
go
from
in
2017
8.654
million
to
blue
cross,
and
then
you
have
the
half
million
dollar
drop?
I'm
I'm
just
not
seeing
why
that
would
be
blue
cross.
As
far
as
I
know,
it's
more
expensive.
The
other
question
I
had
for
you
is
the
type
the
type
of
blue
cross
we
have
do.
We
have
a
type
of
blue
cross
where
you
have
to
have
a
referral,
or
is
this
one
where
they
could
go
pretty
much
the
cadillac
of
blue
cross,
where
they
could
go
pretty
much
anywhere.
D
None
of
the
city's
plans
require
a
referral,
but
there
are
a
lot
of
retiree
or
a
lot
of
active
employees
at
the
city
that
are
enrolled
in
a
qualified
high
deductible
health
plan,
including
a
health
savings
account.
Okay,
this
is
yeah.
This
is
not.
I
would
not
classify
that
as
cadillac
insurance
by
any
means,
but
what
has
happened
is
those
employees
that
have
enrolled
in
the
health
savings
account
they.
D
Those
are
the
ones
that
have
taken
the
time
to
understand
the
finances
of
insurance
and
how
to
make
that
plan
work
for
them,
and
many
of
them
have
come
back
year
after
year,
and
I
know
jennifer's
on
the
phone
and
she's
the
one
that
does
the
open
enrollment
meetings
with
all
the
employees.
They
have
come
back
and
said
you
know
I
was
skeptical,
but
this
is
working
for
me.
D
D
D
E
E
D
So
we
can
do
that
pretty
quick,
so
it's
the
the
enrollment
is
going
to
be
a
little
squishy
because
of
the
way
medicare
enrollees
are
counted.
Medicare
participants
are
actually
counted
individually.
So
if
a
family
like
if
a
retiree
is
eligible
to
cover
a
spouse
in
most
of
the
time,
we
we
consider
that
one
retiree
in
the
medicare
space,
that's
actually
considered
two
retirees.
D
D
So
the
the
actual
so
the
so
our
entity,
plant
moran,
we
are
actually
projecting
costs
every
year
as
part
of
the
renewal,
but
those
projections
are
based
on
the
renewal
documents
that
are
presented
to
us
by
blue
cross
blue
shield
of
michigan.
Okay,
so
we're
we're
projecting
what
claims
costs
are
going
to
be,
but
certain
things
like
the
medicare
advantage
premium.
That's
a
fixed
premium
dollar
so
that
that
rate
is
provided
to
us
by
blue
cross
blue
shield
and
what
all
we
have
to
do.
D
E
Now
my
last
question,
I
don't
know
who's
going
to
answer
it.
If
the
controller
or
the
treasurer
or
the
mayor,
I
noticed
that
there
is
money
left
over
every
year
from
the
money
we
collect
and
it
says,
act,
345
levy
around
600
and
some
thousand
dollars
where
this
money
goes.
Do
we
cost
next
year
or
the
future
year
by
that
amount
or
we
keep
it
then,
in
a.
D
D
D
E
E
What
is
your
recommendation
to
us,
since
we
are
the
ones
who
approve
the
budget
to
speed
up
this,
to
reduce
this
liability
instead
of
30
years?
We
make
it
in
20
years
and
to
make
sure
that
all
the
retirees
from
the
city
are
covered,
so
they
don't
come
to
when
they
they.
You
know,
if,
god,
for
forbid
anything
happen,
there
is
not
enough
money
in
the
fun
yeah.
D
D
Okay,
so,
for
example,
you
know
I
I
don't
necessarily
want
to
give
ourselves
too
much
of
a
pat
on
the
back.
But
you
know
one
of
the
reasons
that
blue
cross
came
in
with
such
a
large
reduction
in
the
medicare
advantage.
Premiums
is
that
plant
moran
has
actually
helped
other
public
employers
move
their
medicare
advantage
business
to
other
carriers,
where
the
competition
is
much
much
stronger
because
of
the
the
integration
with
medicare.
D
Other
other
communities
have
traditionally
said
you
know,
blue
cross
is
the
blue
cross.
Is
the
gold
standard?
We
don't
want
to
move.
There's
sometimes
an
opportunity
to
reduce
costs
in
the
medicare
space
now,
if
you're,
reducing
pay-as-you-go
costs
in
the
medicare
space,
that
has
an
immediate
reduction
in
your
old
pub
liabilities.
D
Okay,
so
those
are
the
types
of
things
you
may
not
do
with
them,
but
the
the
idea
is,
if
there's
a
willingness
to
consider
it.
Sometimes
it
positions
the
the
community
to
negotiate
something:
that's
more
cost
effective
without
having
to
make
any
changes
at
all.
But
if
there's
no
willingness
to
consider
a
change,
an
entity
like
blue
cross
is
going
to
say
what
incentive
do
we
have
to
help
you
control
your
costs,
we're
we're
not
at
risk
of
losing
your
business.