►
Description
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
D
A
A
And
if
you
would
silence
everybody
all
of
your
electronic
devices
that
make
noise,
that
would
be
helpful.
I'm
going
to
limit
public
comment
because
I
think
there
will
be
quite
a
bit
of
it
to
three
minutes
per
person.
I
want
to
remind
everybody:
if
you
didn't
get
to
comment
in
public
or
if
you
don't
get
to
don't,
have
the
ability
to
stay
for
the
second
public
comment
period.
You
can
always
send
peb
your
comment
in
written
form.
A
The
peb
staff
is
really
conscientious.
They
turn
it
around
as
fast
as
they
get
it
and
believe
me,
we
do
read
it
all
when
we're
in
this
room
the
for
the
folks
in
this
room,
not
necessarily
on
zoom.
It
is
my
expectation
that
everybody
keep
their
masks
on.
I
know
we
all
have
coffee
and
water
and
that's
okay,
to
take
your
sips
and
stuff,
but
the
mask
goes
over
your
nose
and-
and
that
includes
when
you're
testifying,
unless
we
can't
hear
you
in
which
case
we'll,
let
you
pull
it
down
a
little
bit.
E
Good
morning,
hopefully
you
can
understand,
maybe
with
the
mask
we
can.
E
Record
I'm
dr
patricia
davin
and
I'm
going
to
read
a
letter
that
I
submitted
to
the
board
and
then
I
just
have
a
couple
of
comments
beyond
that
again,
I'm
dr
patricia
davin,
I'm
a
psychotherapist
in
private
practice.
In
carson
city,
I
provided
services
to
the
state
of
nevada
employees
for
over
40
years,
I'm
also
a
preferred
provider
for
many
insurance
programs.
E
I've
been
working
diligently
with
aetna
signature
administrators
to
receive
in-network
provider
status
due
to
the
discontinuation
of
the
contract
with
hometown
health.
It
is
important
to
me
to
continue
to
provide
services
to
state
employees.
I
submitted
my
application
to
asa
at
the
signature
on
may
5th.
E
I've
been
repeatedly
told
by
aetna
that
I
will
be
receiving
a
contract
via
email
to
date.
No
such
contract
has
been
received.
I
have
further
been
unable
to
ascertain
the
reimbursement
rate
I
may
expect
to
receive
all
phone
calls
are
answered
by
a
call
center
in
the
philippines
and
there
is
no
access
to
the
actual
credentialing
department.
E
In
my
43
years
of
practice,
I
have
never
experienced
such
unprofessional
conduct
and
difficulty
navigating
an
insurance
company.
My
patients
are
frustrated
and
cannot
get
information
from
aetna
as
well.
I'm
hopeful
you'll
reevaluate
this
contract.
My
greatest
hope
is
that
you
may
come
to
some
agreement
with
hometown
health
and
reinstate
that
contract.
E
This
has
become
an
absolute
nightmare
occupying
inordinate
amounts
of
my
time
and
energy
claims
submitted
for
july
21
and
forward
have
been
denied
due
to
aetna's
horrid
handling
of
this
transaction
transition.
Thank
you
in
advance
for
your
consideration
in
this
matter
to
update
you.
This
letter
was
written
on
august
21.
E
I
still
do
not
have
a
contract,
even
though
I
received
a
fax
which
was
received
into
my
office
on
the
26th
of
november,
which
I
got
when
I
came
back
into
the
office
on
monday,
the
29th
indicating
that
I'd
completed
the
credentialing
process
and
that
a
network
representative
would
be
sending
me
an
effective
date
december
2.
I
have
no
contract,
so
two
understatements
for
you
one
is,
I
love
my
work.
E
Two.
These
are
unprecedented
times
in
my
over
four
decades
of
work
with
patients.
I
have
never
seen
the
severity
of
symptoms
that
I'm
seeing
today
anxiety,
depression,
loss,
grief
and
to
compound
it,
my
patients,
many
of
which
had
their
co-pays
doubled
for
some
of
them.
That
meant
that
they
had
to
see
me
less
frequently
in
a
time
when
they
really
needed
to
be
seen
more
frequently.
E
E
F
F
Patty
and
I
ran
into
each
other
this
morning
and
we
both
are
doing
something
very
generous
where
we're
providing
services
without
a
contract
we're
not
getting
paid
from
it
at
all.
I
actually
started
the
process.
I
hired
somebody,
so
it
would
be
expedited,
so
I
could
get
on
the
list
the
in-network
list
very
quickly.
I
don't
have
anything,
I'm
supposed
to
be
getting
a
contract
tomorrow,
but
we'll
see
what
happens
so.
F
Not
only
is
the
the
mental
health
issue
really
important,
but
it's
actually
cost
effective
to
you
to
provide
good
providers,
because
all
the
studies
right
now
are
showing
that
if
people
have
good
mental
health,
they
have
much
better
physical
health,
and
I
have
people
that
need
services,
and
I
can't
provide
everything
for
forty
dollars
an
hour.
F
So
I
I
have
nobody
to
refer
even
to
in
because
there's
there's
so
few
people
available.
F
So
thank
you
very
much
for
giving
this
attention
and
I
do
hope
that
you
go
into
with
a
better
insurance
company
like
hometown
health.
Thank
you
very
much.
B
B
Good
morning
my
name
is
brooke
malef
for
the
record,
and
I
have
submitted
written
comments,
and
let
me
just
thank
you
for
the
opportunity
here
to
speak
quickly,
it's
time
that
the
the
pebb
administration
and
the
discriminating
exclusions
for
covering
transgender
services
in
the
in
the
health
plan,
unlike
some
people,
want
to
believe
suffering
from
gender
dysphoria
is
not
a
choice,
but
the
treatment
to
be
able
to
help
mitigate
the
impact
of
gender
dysphoria
is
the
the
right
thing
to
do
for
the
for
people
through
an
appropriate
medical
intervention
plan
that
differs
for
each
individual.
B
We
can
go
into
detail
in
other
areas
as
to
what
really
needs
to
be
covered.
We've
been
talking
about
this
now
for
a
year.
The
resistance
to
this
exclusion
must
stop.
We
are
talking
about
a
100th
of
a
percent
of
the
cost
of
overall
spending
to
be
able
to
cover
additional
treatments
for
gender
dysphoria.
B
Why
are
we
trying
to
balance
a
budget
on
the
facts
of
the
small
number
of
people
who
desperately
need
these
services?
Please
consider
this.
Please
look
at
reversing
the
exclusionary
language
that
are
in
the
health
plans
that
prevent
appropriate
treatment
for
medically
necessary
procedures
for
gender
dysphoria.
Thank
you
for
your
time.
G
A
strong
benefits
program
is
essential
for
the
recruitment
and
retention
of
high
quality
faculty
and
other
state
employees,
but
unfortunately
the
cuts
to
pebb
have
undercut
that
goal
for
agenda
item
6
on
the
nevada
faculty
alliance
is
neutral
on
coveted
surcharges.
All
nc
employees
are
required
to
be
vaccinated
as
a
condition
of
continued
employment.
G
After
the
end
of
this
year
with
medical
and
religious
exemptions,
therefore,
nc
employees
should
be
exempted
from
any
additional
requirements
bypass
to
document
their
vaccination
status
agenda
item
7
states
that
26
million
of
the
47
million
excess
reserves,
as
of
the
beginning
of
the
fiscal
year,
are
available
for
enhancing
benefits.
That
is
a
conservative
estimate.
G
The
proposal
to
stretch
those
funds
over
three
years
is
very
concerning
every
biennium.
For
the
past
dozen
years,
pebb
has
made
plans
to
spend
excess
reserves
down
to
near
zero
by
the
end
of
that
biennium.
But
even
that
has
never
happened.
Projections
that
are
overly
conservative
hurt
participants
by
forcing
cuts
to
benefits
that
then
become
permanent
option.
Three
in
agenda
item
seven
comes
closest
to
restoring
prepa
pre-pandemic
benefits,
except
for
life,
insurance
and
long-term
disability,
and
therefore
is
strongly
preferred.
G
The
estimated
cost
of
11
million
per
year
is
well
within
the
available
excess
reserves
for
fy,
2023
and
beyond
option
three
should
be
recommended
by
the
board.
Then
let
the
governor
and
interim
finance
committee
make
the
final
decision
for
section
21
of
sb
459
option.
Three
as
amended,
however,
still
does
not
fully
restore
the
hmo
epo
to
zero
percent
co-insurance,
leaving
at
10
or
20
percent
for
not
sure
which
services
this
should
be
corrected,
even
if
it
raises
employee
premium
spec,
fy,
21
levels.
G
It
is
important
that
the
design
for
the
low,
deductible
and
hmo
epo
plans
make
the
additional
premiums
that
employees
pay
worthwhile
to
them
for
fy
22,
the
deductibles
and
coinsurance
for
the
hmo
edo
plans
have
led
to
dissatisfaction
and
uncertainty
and
cost
the
whole
idea
and
attraction
of
a
high
premium.
Hmo
style
plan
is
providing
certainty
and
costs
through
fixed
co-pays.
B
E
Thank
you
real
quickly.
I
think
chair
freed
in
the
interest
of
efficiency.
What
I'm
going
to
do
is
just
do
four
bullet
points
of
the
following
tracking
the
actual
agenda
items
in
no
particular
order.
The
easier
ones
in
the
sense
of
none
of
these
things
are
easy.
This
morning,
however,
the
more
straightforward
ones
I
should
say,
are
on
agenda
item
six
asked
me
reads:
chapter
4041
retirees
are
neutral
on
this
agenda
item
that
doesn't
suggest
that
there
has
been
a
brief
or
sketchy
back
discussion.
There
have
been
extensive
discussions.
E
Afscme
international
has
supported
that
all
americans
get
vaccinated
as
soon
as
possible
since
the
beginning
since
the
inception
of
the
of
the
pandemic.
E
So
we
are
neutral
on
agenda
item
six
on
agenda
item,
seven
again
in
the
interest
of
efficiency
and
also
recognizing
the
excellent
work,
the
nevada
faculty
alliance.
Does
we
agree
and
would
like
to
piggyback
on
all
the
comments
that
dr
ervin
just
made,
and
also
what's
in
the
written
public
comments
from
dr
douglas
unger?
E
We
agree
that
I
that
option
three
most
most
closely
gets
us
back
to
pre-pandemic
levels
with
those
adjustments,
as
mentioned
by
dr
irvin,
on
on
plan
design
for
for
the
future
for
2020
or
2023
and
then
finally
on
agenda
items,
because
these
two
dovetailed
together
4.2
the
american
rescue
plans,
funds
requests
and
agenda
item
5.
The
executive
officer
report,
as
ms
rich
has
gone
over
already
in
advance
with
us.
E
As
you
know,
on
our
pre-board
meeting
on
monday,
we
are
deeply
disappointed
in
what
is
represented
as
being
the
governor's
office
position
on
the
american
rescue
fund
funding
to
restore
pebb
cuts.
There's
been
much
discussion
of
one-time
monies,
but
I
would
remind
this
body
that
in
in
2020
at
ab3
the
31st
special
session
section
131.1
to
be
specific.
E
This
state,
the
state
government,
had
no
hesitation
in
sweeping
pebb
funds
in
a
one-time
act
in
direct
response.
That
was
what
was
articulated
to
the
legislature
in
response
to
the
shortfalls
because
of
the
pandemic
crisis.
So
there
is
an
opportunity
here,
2.7
billion,
as
we
all
know,
to
restore
at
a
bare
minimum.
What
was
swept
in
that
special
session,
and
I
would
certainly
urge
this?
Yes,
I'm
wrapping
it
up.
Yes,.
B
B
Doug
unger
d-o-u-g
u-n-g-e-r
president
unlv
chapter
affairs,
representative,
nevada,
faculty
alliance.
Thank
you,
chair
freed
and
members
of
the
pet
board
for
your
service
and
to
executive
officer
laura
rich
for
her
good
commitment
for
the
record.
G
B
Again-
and
I
won't
waste
your
time
repeating
other
points,
but
just
we
really
must
express
how
disappointed
we
are,
at
the
governor's,
apparent
lack
of
support
for
restoring
pet
benefits
towards
american
rescue
plan
funds.
Again,
I'd
like
to
point
out
that
the
governor
legislature
do
not
even
indicate
they
put
back
the
25
million
the
legislature
swept
from
the
feb
budget
due
to
the
covet
19
economic
crisis,
and
that
this
is
the
first
time
in
the
history
of
them
that
such
a
sweep
has
not
been
restored.
B
We
are
baffled
as
to
why
we
appreciate
headboard
support
for
our
strong
requests
to
the
governor
legislature
to
restore
the
pep
budget
and
benefits
to
pre-pandemic
levels
regarding
the
agenda
for
today
for
item
six,
the
copenhagen
surcharge.
As
has
been
said,
the
nfa
takes
a
position
either
for
or
against.
B
B
We
urge
the
board
to
vote
for
option
number
three,
which
offers
plans
closest
to
restoring
benefits,
lowering
the
deductibles
and
out-of-pocket
maximums
the
most
to
bring
relief
to
those
most
in
need
and
if
option
number
three
begins
to
appear
unsustainable
because
of
anticipated
plans.
There
is
time
to
make
adjustments
next
year.
Regarding
agenda
item
eight,
the
new
contracts
under
consideration.
B
We
can't
express
enough
praise
for
and
even
amazement
at
the
dedicated
work
and
due
diligence
that
the
pet
staff
executive
officer,
rich
and
the
board
have
devoted
to
stewarding
so
many
contracts
through
the
rfp
process
in
a
single
year.
We
support
pebb's
recommendations.
You
all
deserve
a
bonus
and
an
extra
vacation
time.
We
wish
we
could
unwrap
that
for
you
as
a
gift,
but
instead
will
simply
thank
you
and
wish
you
happy
healthy
holidays.
Thank
you.
E
E
I'm
the
executive
director
at
r-pen,
the
retired
public
employees
of
nevada.
Our
pen
was
formed
in
1976
and
we
currently
have
close
to
8
000
dues
paying
members.
The
bulk
of
our
membership
is
retired
public
employees,
although
we
do
have
close
to
a
thousand
members
who
are
still
working
and
who
would
be
directly
impacted
by
item
6.3
on
today's
agenda,
a
surcharge
on
roughly
5000
unvaccinated
participants
and
about
1600
of
their
dependents
executive
officer.
Rich
will
speak
on
the
reason
for
the
surcharge,
and
you
will
see
a
letter
from
one
of
our
members.
E
Who's
expressed
a
strong
opinion
on
this
matter
as
well.
Our
pen
being
a
non-profit
nonpartisan
organization,
will
not
take
a
position
one
way
or
the
other
at
issue
those
cost
of
the
surcharge
and
what
will
how
it
will
burden
many
public
employees
who
are
already
dealing
with
escalating
health
care
costs
coming
out
of
their
paychecks,
especially
their
in
entry
level
positions
earning
lower
salaries
than
many
of
their
counterparts.
E
In
addition,
because
of
the
pandemic
and
the
impacts
on
the
state
budget,
governor
susalak
eliminated
long-term
disability
and
made
other
cuts
to
participants
amounting
to
close
to
25
million
dollars
that
our
pen
and
our
advocacy
groups
would
like
to
see
return
to
pebb
through
the
covid
federal
rescue
funding
that
the
state
received
earlier
this
year,
amounting
to
nearly
three
billion
dollars.
Unfortunately,
though,
as
you
heard
in
previous
public
comment,
we
did
hear
this
week
that
the
governor
has
informed
ms
rich,
that
pebb
will
not
be
receiving
any
of
those
federal
dollars.
E
That
is
extremely
disappointing
in
light
of
so
many
other
sacrifices.
These
participants
have
already
made
it's
as
if
pebb
through
this
surcharge
is
being
forced
to
come
up
with
its
own
care
funds
to
deal
with
this
issue
that
they
face
through
no
fault
of
their
own.
So
we
urge
this
board
to
seek
other
options
to
help
cover
all
coveted
related
costs,
rather
than
overburden
state
employees
with
more
fees
and
instead
look
toward
the
governor's
office
for
relief
through
that
federal
funding
early
received
earlier
this
year.
E
B
Hi
hi,
my
name
is
stephanie
parker
and
I'm
a
member
of
aston
local
4041
and
a
state
employee
with
over
13
years
of
public
service
with
the
state
of
nevada.
I
want
to
voice
my
dissatisfaction
with
the
lack
of
part
of
the
governor's
office
finance
office
to
restore
benefits
of
the
public
service
workers
who
continue
to
serve
the
communities
of
this
state
during
the
pandemic,
with
the
ability
that
they
have
with
the
funds
from
the
american
rescue
plan.
B
B
I
share
the
sentiments
of
the
previous
speakers
and
item
number
seven
when
you're
considering
the
three
options
to
go
with
the
one
that
is
less
burdensome
on
the
actual
members,
and
that
would
be
item
number
three
or
option
number
three
I'd
like
to
see
the
pep
board.
Take
stronger
stand
to
restore
the
benefits
that
were
taken
and
stop
allowing
them
minimize
the
impact
these
cuts
have
had
on
employees
who
are
on
the
front
lines.
Thank
you.
B
G
G
D
k-e-n-n-e-d-y
and
I'm
the
chapter
president
for
the
nevada
state
college
chapter
of
the
nevada
faculty
alliance-
I'm
here
today
to
advocate
I'm
here
today
for
agenda
item
seven
to
personally
advocate
for
option
number
three
of
the
revised
plan
designs
as
these
are
closest
to
pre-pandemic
plans.
G
No
family
should
be
subjected
to
a
maximum
pocket
cost
of
ten
thousand
dollars
annually
or
be
subjected
to
paying
thousands
of
extra
dollars
per
year
in
premium
costs
with
reduced
benefits
as
a
parent
to
a
five-year-old
boy
is
a
bleeding
disorder.
I'm
especially
troubled
by
these
insurance
plans.
My
son
grayson
has
severe
hemophilia
a
and
requires
monthly,
intravenous
infusions
to
prevent
internal
bleeding
and
longer
bleed
times.
If
he
does
get
injured.
G
However,
under
the
current
plans,
we've
experienced
an
incredible
amount
of
financial
stress
to
obtain
his
medication,
which
the
copays
can
range
anywhere
from
six
to
eight
thousand
dollars
per
month,
because
these
astronomical
co-pays
are
not
possible
for
the
vast
majority
of
americans.
We
also
have
to
rely
on
financial
assistance
to
partially
offset
the
medical
costs
associated
with
this.
G
Managing
our
son's
bleeding
disorder
is
difficult
enough
without
having
to
wonder
whether
or
not
we
will
be
able
to
afford
his
life-saving
medication.
On
top
of
that
now
I
understand
that
the
pep
board
can
only
do
so
much
with
the
funds
they've
been
given,
and
I
appreciate
all
of
their
hard
work
on
the
matter,
but
on
might
be
on
behalf
of
my
family
and
others
in
similar
situations,
I'm
asking
the
pet
board
to
please
reinstate
the
previous
pep
benefits
to
pre-pandemic
standards.
E
E
Outcome-Based
health
contingent
programs
as
a
part
of
a
pebb
health
and
wellness
program
have
not
been
implemented
in
previous
years,
as
they
were
looked
at
and
considered
discriminatory
in
a
stretch
to
comply
with
hipaa.
Perhaps
I'm
out
of
touch.
Do
we
apply
a
surcharge
on
smokers,
type,
2,
diabetics,
obese
persons
due
to
excess
food
intake,
persons
that
attempt
suicide
or
any
of
the
other
medical
conditions
that
occur
due
to
personal
health
choices?
E
E
E
Current
health
reports
indicate
that
vaccination
does
not
permanently
guard
against
covid19
or
the
variants
and
does
not
stop
transmission.
Will
pebb
refund
the
fees
when
it's
determined
that
all
persons
need
to
be
continually
tested
to
ensure
that
they
too
are
not
a
danger
to
society
of
the
available
options.
I
sincerely
hope
that
the
peb
board
recognizes
surcharges
discriminatory,
not
consider
the
pebb
staff
recommended
covid
testing
surcharge
and
instead
say
no.
Should
it
come
to
vote.
E
Thank
you.
I
do
also
want
to
add
that
do
not
be
pushed
by
staff
to
make
such
an
unprecedented
decision
based
on
their
calendar
schedule,
take
the
time
to
really
consider
it
and
take
the
time
to
let
this
hand
flush
out
a
little
more
before
you
start
charging
people
for
unnecessary
expenses.
Thank
you.
A
B
B
B
B
The
current
year's
health
care
benefits
have
been
detrimental
to
many
of
my
co-workers
to
the
point
that
many
are
unable
to
utilize
our
health
care
coverage,
except
for
basic
things.
We
save
a
bill
for
nearly
every
service
we
get.
Some
are
paying
thousands
of
dollars
for
diabetic
supplies
that
were
low
cost
or
free
in
the
past.
This
is
unacceptable
with
the
cuts
to
our
pay
this
year.
B
B
G
My
comment
is
in
regards
to
item
6.3.
I
believe
option
number
two
is
the
best
for
for
us
to
continue.
100
coverage
for
covet
19
treatment
related
claims
as
a
single
income
family.
The
hike
of
the
insurance
this
last
year
has
now
caused
me,
4
331.76
that
I
have
to
pay
now
for
my
yearly
insurance
for
my
family
pers
increase
24,
I
just
lost
another
20
per
pay
period,
so
it
comes
out
to
520
this
55
a
month.
Surcharge
would
be
an
additional
660.
G
So
now
I've
worked
for
the
state
of
nevada
23
years
four
months
and
I'm
going
to
and
be
losing
dollars
and
sixty
four
cents
per
year
we
haven't
had
any
raises
your
state
of
nevada
employees
that
work
very
hard
are
normally
paid
twenty
to
thirty
percent,
less
than
your
city
and
county
workers.
G
We
have
a
high
turnover
rate.
According
to
the
las
vegas
review
journal,
with
135
percent
turnover
rate
in
2020
people
are
leaving
due
to
pay
and
benefits.
I
believe
this
is
going
to
further
hurt
the
state
of
nevada.
We
have
less
employees.
Employees
are
being
placed
in
immediate
danger
on
a
daily
basis.
In
my
area,
due
to
short
staffed,
I
have
some
of
the
best
state
employees.
Actually,
I'm
honored
to
be
the
supervisor
of
a
state
of
nevada
employee
of
the
year.
G
F
B
A
A
B
B
A
Okay,
seeing
none
then
I
will
move
to
agenda
item
six.
Like
I
said
earlier,
I'm
gonna
move
four
and
five
down
below
six
and
seven.
So,
let's
go
to
agenda
item
six.
Everyone.
C
All
right
for
the
record,
laura
rich
executive
officer
of
the
public
employees
benefits
program.
Before
I
begin
presenting
this
report,
I
do
want
to
start
out
by
letting
the
board
know
that
we
do
have
a
few
folks
here
in
attendance
who
will
be
available
for
questions
director.
Dwayne
young
he's,
a
policy
director
for
the
office
of
the
governor
is
here,
and
we
also
have
some
representatives
from
all
of
our
vendor
partners,
as
well
as
a
representative
from
the
nevada
system
of
higher
education
as
well.
C
I'm
going
to
deviate
a
little
bit
from
this
report
at
least
the
way
it
was
written.
There's
a
lot
of
information
in
here
and
all
of
the
separate
items
sort
of
bleed
into
each
other.
So
I'm
going
to
try
to
present
it
in
a
way
that
flows
a
little
bit
better
than
the
way
it's
written
in
the
report
also,
I
plan
to
go
over
each
option
during
the
presentation,
but
since
they're
so
interrelated.
C
I
think
it's
best
if
I
go
through
the
entire
report
first
and
then
take
all
the
we'll
take
all
the
action
items
all
once
at
the
end
after
discussion.
C
C
Although
pep
was
not
subject
to
the
requirements
of
the
emergency
declaration,
the
board
at
the
time
opted
to
cover
the
covid
testing
consistent
with
the
regulation
we've
we
followed
that
pretty
consistently
and
also
treatment
at
a
hundred
percent.
C
We
discussed
this
at
the
september
board
meeting
because
we
had
we,
the
pep
staff
had
brought
to
the
board
the
option
to
restore
cost
sharing
and
and
after
some
discussion,
this
was
tabled
and
asked
to
bring
staff
was
asked
to
bring
this
back
to
the
to
the
board
at
this
meeting.
So
in
that
time,
pep
reached
out
to
public
employers
throughout
the
country
and
the
state
and
confirmed
that
many
of
the
plans
out
there
insurers
had
done
exactly
what
we
had
done.
C
They
had
suppressed
or
or
not,
enforced,
cost
sharing
on
coveted
claims,
however,
out
of
11
states,
only
one
state
which
is
hawaii
has
indicated
plans
that
they're
going
to
or
have
they've
actually
most
states
have
actually
ended
that
and
only
hawaii
is
continuing
to
waive
the
cost-sharing
option.
So
the
remaining
states
plus
six
of
nevada
public
sector
plans,
as
well
as
the
culinary
health
plan,
have
ended
that
and
so
they've
reinstated
cost
sharing
for
covet
claims.
C
cost
sharing
for
members
on
pub's
fully
insured
hmo
plan
offered
in
southern
nevada
was
waived
by
hpn,
beginning
in
february
2020,
but
at
the
end
of
december
2020
or
at
the
end
of
december
of
2020,
they
actually
return
that
cost
sharing
as
well.
So
as
a
result,
there's
already
inconsistencies
among
the
ped
plants.
C
Health
plans
are
no
longer
waiving
these
costs
and
another
10
percent
of
the
plans
phased
out
waivers
by
the
end
of
october,
2021,
so
pebb
since
we
have,
we
have
paid
for
the
cost
sharing
for
members
and
all
of
their
covet
claims
since
april
of
2020,
which
is
when
the
vaccine
became
widely
available,
pebb
has
paid
in
member
cost,
sharing
cost
about
3.2
million
dollars,
and
that
is
for
out-of-pocket
expenses
for
covet-19
treatment
and
hospitalization
for
members
that
are
on
our
self-insured
plan.
So
remember
those
on
the
hmo
did
not
receive
that.
C
At
the
september
30th
meeting
the
board
requested
additional
information
regarding
various
cost-sharing
reinstatement
options.
We
discussed
possibly
restoring
cost
sharing
for
unvaccinated
members
only
or
maybe
by
age.
You
know
there
were
there
were
several
discussions
and
so
pep
went
back
to
the
table
and
we
looked
at.
We
did
some
research
and,
and
basically
we
found
out
that
hipaa
prohibits
plans
like
pad
from
discrimination
based
on
health
conditions.
C
C
C
So,
first,
we're
going
to
start
with
the
testing
mandates
I'll
start
with
the
federal
mandate
first,
because
I
think
that
that's
it's
easier
to
start
with
that
and
then
go
through
the
state
mandates.
So
on
november,
4th
the
biden
administration,
along
with
the
occupational
safety
and
health
administration,
which
is
osha,
publish
an
emergency
temporary
standard
ats.
C
This
new
rule
requires
that
large
employer,
so
that's
defined
as
100
employers
or
more
administer
weekly
testing.
For
their
unvaccinated
workforce
starting
january
4th
2022,
the
rules
here
are
clear
that
the
costs
associated
with
testing
fall
either
on
the
employer
or
the
employee,
and
that
the
decision
falls
on
the
employer
as
to
who
gets
to
absorb
those
costs.
C
Since
then,
this
has
been
challenged
in
the
courts
and
the
fifth
circuit
court
of
appeals
granted
a
motion
to
stay
the
ets,
so
this
federal
mandate
is
now
in
limbo
until
further
action
is
taken.
However,
let's
move
to
the
state
mandate,
the
state
mandate.
Last
august,
the
state
implemented
a
weekly
testing
requirement
for
all
unvaccinated
employees.
C
C
No
one
at
pebb
has
had
to
test
no
one
vaccinated
employees
that
have
have
had
to
test
since
day,
one
because
our
building
was
designated
as
a
building.
That
was
over
that
70
percent
vaccination
rate
since
day.
One,
the
division
of
public
and
behavioral
health
secured
on-site
vendors
to
perform
these
weekly
tests
at
several
locations
throughout
the
state,
at
a
cost
of
about
a
hundred
and
thirty
dollars
a
test.
C
So
the
numbers
that
of
employees
that
tested
varied
week
by
week,
but
the
average
was
about
2700
that
we're
testing
a
week
and
that
number
has
since
dropped
pretty
significantly
because
more
and
more
work
sites
are
meeting
that
70
threshold.
C
So
it
looks
like
the
state
is
going
to
continue
the
weekly
testing
and
to
align
with
the
direction
being
taken
with
the
or
by
the
by
the
white
house.
It
is
likely
that
that
70
percent
workplace
threshold
will
be
eliminated,
so
that's
leaving
about
5
thousand
state
employees
required
to
submit
to
weekly
testing
because
they're
unvaccinated,
also
dpbh's
contract
using
it
used,
cares
act
funding
is
it
is
expiring
on
december
17th,
meaning
that
the
state
will
need
to
figure
out
another
funding
source
to
cover
these
costs
moving
forward.
C
So
the
most
recent
numbers
that
I
received
from
enchi
and
this
may
be
updated
since
then,
it
shows
that
813
remain
unvaccinated
and
341
employees
have
received
exemptions
and
she
has
a
deadline
of
december
31st.
So
any
employees
that
have
not
been
vaccinated
or
received
an
exemption
by
then
will
be
terminated.
C
C
Section
6001
of
the
family's
first
act
requires
that
health
plans
cover
cobit
19
diagnostic
testing,
we'll
talk
about
diagnostic
and
surveillance
in
a
minute
at
no
cost
to
the
member
during
the
national
public
emergency
period,
so
that
ffa
does
not
require
plans
to
cover
surveillance
testing.
Peb
is
currently
covering
all
types
of
testing
clamps.
So
what
is
the
difference
between
diagnostic
testing
and
surveillance?
C
C
The
difference
is
here
that
a
diagnostic
test
is
mandated
to
be
covered
by
insurers,
whereas
surveillance
is
not
most
insurers
nationwide
do
not
cover
surveillance
testing.
The
problem
is
that
there's
again
very
little
formal
guidance
on
what
qualifies
as
a
diagnostic
test
and
what
qualifies
as
surveillance.
C
In
fact,
pebb
has
seen
only
five
surveillance
claims
come
through
our
program
since
the
beginning
of
the
the
pandemic.
So
what
I'm
hearing
from
the
industry
is
that
insurers
are
having
to
dedicate
resources
to
identify
possible
claims
that
are
being
submitted
by
providers
that
are
likely
surveillance
and
not
diagnostic.
So
what
does
that
that
mean?
C
That
means
that
when
they
see
a
provider
submitting
a
claim
for
john
smith
for
a
cova
test
week
after
week
after
week,
that
is
likely
a
surveillance
test
and
not
a
diagnostic
test,
so
so
providers
are
insurers
are
having
to
dedicate
resources
to
sift
through
this
and
identify
that
and
push
back
on
insurers
they're
pushing
back
on
providers
and
without
real,
clear
guidance.
I
think
it's
easy
to
understand
why
this
can
be
a
problem
once
more
and
more
employers
begin
implementing
testing
requirements,
given
that
many
employees
were
already
testing
through
other
channels.
C
So
pebb's
ability
to
leverage
existing
resources
and
steer
members
may
help
contain
costs
and
better
project
expenses
associated
with
this
testing.
Those
peb
staff
began
to
work
with
our
partners
to
research.
These
efforts,
we
discovered
that
billing
for
covet
testing
is
anything
but
simple.
It
can.
It
can
vary
widely
and
providers
have
a
lot
of
discretion
on
what
and
how
covet
related
claims
are.
Built.
C
Testing
can
range
anywhere
from
zero
dollars
to
hundreds
of
dollars.
So
what
pep
discovered
was
that
claims
built
through
pharmacy
are?
They
can
be
billed
to
the
feds
through
an
agreement
between
pharmacies
and
hhs,
since
these
claims
don't
go
through
the
pbm
pebb
has
no
data
on
how
many
employees,
how
many
ped
members
have
have
had
a
test
administered
through
this
option,
but
there's
an
exception
to
that.
We
also
found
that
members
who
had
access
pharmacy
minute
clinics
or
drive-through
testing
they
were
being
built
through
medical.
C
These
costs
were
somewhere
in
the
hundred
and
thirty
dollar
range
because
they
included
the
testing
and
then
also
the
associated
provider
visit
then
there's
other
options
such
as
lab
core
request,
and
they
tend
to
be
somewhere
in
the
75
range
and
then
there's
higher
cost
facilities.
If
you
go
to
an
urgent
care
center
or
something
like
that,
it
can
be
several
hundred
dollars
for
a
coveted
test.
Finally,
there's
other
options
that
are
free
because
insurance
information
is
never
collected,
so
that
can
be.
C
You
know
options
such
as
health
district
testing
sites
so
to
come,
full
circle,
both
nc
and
the
state
will
be
conducting
employer
testing
neither
are
funded
to
absorb
those
costs
moving
forward.
So
shifting
the
cost
on
to
the
employee
potentially
opens
up
a
loophole.
C
C
This
is
not
inclusive
that
3.4
million
dollars
is
not
inclusive
of
the
cost
paid
through
the
dpbh
on-site
testing
contract
so
delivering
the
weekly
testing
through
insurance
will
allow
pebb
to
control
and
plan
for
costs.
Pep
has
been
exploring
other
options
that
replicate
the
state's
current
on-site
testing
process
and
we
have
several
options
that
appear
to
be
very
viable.
C
One
option
is
offering
an
on-site
solution,
which
is
about
sixty
dollars,
a
test
and
another
option:
we're
looking
at
explores
a
self-administered
at-home
testing
service,
using
a
telemedicine
type
provider
who
oversees
the
testing
and
then
logs
that
re,
the
the
results,
that's
about
half
that
cost
at
about
33
a
test.
C
While
these
options
have
yet
to
be
flushed
out,
it
allows
pebb
to
pivot
quickly
and
better
plan
for
future
liabilities
of
the
program.
So
the
options
here
really
we're
looking
at
one
is
to
deny
coverage
for
surveillance
testing.
We
can
do
that,
but
we
all
know
that
no
one's
billing
using
surveillance
codes
providers
are
billing
using
diagnostic
codes,
and
until
that
changes
the
plan
is
going
to
be
really
liable
for
for
all
those
those
costs
that
come
in
for
for
testing.
C
So
the
second
second
option
is
to
provide
a
hundred
percent
coverage
for
surveillance
testing
only
through
pub
approved
solutions.
So
these
are
low-cost
solutions.
We
can
steer
members
to
and
provide
to
better,
be
able
to
plan
for
the
cost
of
the
testing
program,
and
then
the
third
option
is
to
continue
to
provide
100
coverage
for
all
covet
testing.
C
It's
important
to
note
here
that,
no
matter
what
the
health
plan
will
likely
assume
increased
costs
related
to
this
overall
increase
in
mandated
testing,
not
just
for
the
state
but
other
employers
who
want
to
put
this
into
place.
If
people
use
providers
who
are
billing
this
as
a
diagnostic
test,
insurers
will
be
subject
to
pay
for
that,
because
we
are
federally
mandated
to
pay
for
covered
19
claims
testing
claims.
C
A
recent
survey
indicated
that
about
70
percent
of
unvaccinated
employees
would
be
motivated
to
get
vaccinated
if
surcharges
were
imposed
on
them.
Delta,
airlines
and
several
other
private
employers
have
implemented
surcharges
already
as
a
way
to
recoup
covet
related
costs
on
their
self-funded
health
plans
delta
estimated
that
the
average
coveted
hospitalization
cost
on
their
plan
is
about
50
thousand
dollars.
In
some
instances,
employers
have
reported
that
their
vaccination
rates
have
increased
about
twenty
percent.
C
After
a
surcharge
was
imposed,
pep
reached
out
to
other
public
sector
health
plans
and,
while
most
had
not
implemented
a
surcharge
of
this
type,
many
many
many
were
interested
and
expected
to
consider
it
at
some
point.
Those
health
plans
that
we
reached
out
to
were
had
asked
pebb
to
share
with
them
what
you
know
what
pebb
discovers
going
down
this
track.
C
C
Just
this
week,
pep
had
a
claim
come
in
for
half
a
million
dollars
in
bill
charges
for
a
patient
that
was
hospitalized
from
covid
who
later
passed
away.
I've
told
this
story
before
I
think
at
every
board
meeting
there's
there's
several
copied
stories
that
pep
has
shared
with
the
board
and
the
public.
C
This
is
this
is
not
going
away.
These
costs
are
here
to
stay,
and
yesterday
I
happened
to
look
at
a
report
of
pending
high
cost
claims.
Those
those
are
claims
that
have
not
yet
been
paid
and
are
over
a
hundred
thousand
hundred
thousand
dollars
and
six
out
of
the
top
20
highest
cost
claims
were
due
to
a
covid
diagnosis.
C
So
there's
definitely
it's
it's
quite
clear.
That
covet
is
a
major
cost
driver
in
terms
of
treatment
and
hospitalization
costs.
Now
we
have
an
additional
factor,
which
is
employee
testing
costs.
The
combination
of
both
of
these
potential
costs
put
the
plan
in
a
situation
where
we
must
identify
revenue
sources
to
cover
these
increases.
C
Pebb
is
largely
a
taxpayer
funded
plan
outside
of
employee
premiums.
It's
a
tax
payer
funded
plan,
and
since
we
do
not
have
the
ability
to
adjust
the
state
subsidy
portion
outside
of
legislative
session,
we
have
no
choice
but
to
look
at
other
options.
The
only
revenue
option
that
leaves
us
with
is
is
the
employee
premium
side
right.
So
we
do
not
collect
additional
revenue
to
offset.
C
Hipaa
prohibits
health
plans
from
discriminating
against
participants
based
on
a
health
factor.
A
health
factor
can
be
an
individual's
health
status,
a
medical
condition
or
receipt
of
health
care.
Vaccination
status
falls
under
that
category
as
well,
but
despite
this,
hipaa
permits
different
premiums
for
participants
complying
with
programs
of
health
promotion
and
disease
prevention,
so
aka
wellness
programs.
C
These
are
two
types
of
well.
There
are
two
types
of
wellness
programs
at
participatory
which
basically
uses
the
carrot
method
to
incentivize
a
member
to
satisfy
a
health
requirement
and
then
there's
the
health
contingent.
A
health
contingent
program
is
broken
out
into
two
categories:
activity-based
and
outcome-based,
requiring
a
member
to
pay
a
higher
premium
to
obtain
a
particular
health
status
like
a
coven-19.
Vaccination
is
an
outcome-based
program.
C
Outcome-Based
programs
must
offer
reasonable
alternatives.
So
in
the
case
of
a
coveted
surcharge,
the
plan
will
have
to
provide
another
way
for
an
unvaccinated
member
to
avoid
the
surcharge
and
pay
the
same
premium
as
a
vaccinated
member.
The
most
common
practice
here
is
to
offer
a
waiver
option
for
health
or
religious
purposes.
C
C
C
Ultimately,
though,
the
surcharge
is
limited
to
30
percent
of
the
total
cost
of
the
employee.
Only
coverage
using
this
information
pep
determined
that
the
limit
for
the
employee
surcharge
is
kept
at
fifty
five
dollars.
So
we
cannot
impose
anything
more
than
fifty
five
dollars
on
an
employee,
while
dependent
surcharges
must
still
comply
with
hipaa
wellness
rules.
They're
not
subject
to
the
same
limitations
that
employee
surcharges
are
so
employers
have
a
lot
more
flexibility
in
dependent
surcharges
in
that
amount.
C
So
in
this
we
had,
we
took
some
assumptions
and
again
there's
a
good
possibility
that
these
assumptions
will
change
because
out
of
those
5
000
employees,
we
don't
know
how
many
have
you
will
get
vaccinated.
How
many
will
get
exemptions?
C
How
many
are
remote
workers
who
are
not
subject
to
this
right,
and
so
there
are
some
assumptions
here
that
we're
using
the
first
one
is
cost.
So
originally
we
were
looking
at.
You
know
the
different
types
of
testing
and
what
we
could
expect
these
costs
to
come
in
at
for
the
the
testing
cost
and
we're
looking
at
probably
40,
60,
80,
so
low
medium
high
right
and
that's
based
on
our
ability
to
steer
members
to
to
our
preferred
cost
options.
C
We're
also
looking
at
you
know
the
5
000
unvaccinated
state
employees
at
the
time
that
this
report
was
written.
You
know
the
the
1250
unvaccinated
ng
employees,
95
of
them
being
enrolled
in
pebb
and
then
we're
looking
at
five
percent
surcharge
exemption
rate.
This
is
based
on
a
on
internal
tracking
of
experience
using
other
other
private
sector
health
plans.
They're
looking
at
five
percent
received
an
exemption
or
a
waiver,
and
then
the
dependent
surcharge
assumes
dependents,
18
years
of
age
or
older.
C
C
C
So
this
really
I
mean
looking
at
the
the
medium
here-
is
we're
looking
at
about
18
million
dollars
that
we
are
anticipating
of
expenditures
related
to
this,
and
this
is
not
including
medical
costs.
This
is
just
including
the
testing,
and
so
through
these
surcharges,
the
55
and
175.
C
The
expected
revenue
here
would
be
about
that
18
million
that
is
necessary
to
you
know
raise
that
revenue
to
meet
the
expenditure
costs
so,
like
I
said
it's
important
to
know,
this
is
a
very
fluid
situation
and,
as
pebb
receives
more
accurate
data
around
these
numbers,
the
projections
and
the
tables
may
likely
change
and
we
do
have
the
ability
in
the
future
to
make
some
adjustments
moving
forward.
C
C
Looking
at
in
in
terms
of
you
know
how
many
employers
are
looking
at
surveillance,
testing,
vaccination
numbers,
remote
workers
and
then
also
terminations,
how
many,
how
many
of
those
ng
employees
that
are
left
are
will
be
terminated
on
december
31st,
hospitalization
costs,
like
I
said,
I
mean,
we've
got
a
whole
lot
of
pending
costs
out
there
that
are
covet
related,
and
then
we
have
that
covet
pill
that
is
likely
due
to
be
released
or
approved.
Hopefully,
in
you
know
the
next
coming
months
and
the
cost
to
that
could
be.
C
So
as
more
data
is
gathered,
pebb
expects
to
adjust
the
dependent
surcharge
amount,
but,
like
I
said,
we
really
do
need
to
start
somewhere,
and
this
is
from
the
data
we
have
today
that
the
175
and
55
is
what
we're
looking
at
so
the
process.
C
A
lot
of
it
is
not
flushed
out
yet
because
again
we're
in
the
early
stages,
but
pebb's
new
enrollment
and
eligibility
system
vendor
has
implemented
functionality
that
allows
employers
to
administer
a
coveted
surcharge
similar
to
how
smoking
surcharges
are
managed,
employees
would
have
the
ability
to
upload
copies
of
their
vaccine
cards
beginning
in
january
through
the
end
of
open
enrollment
in
in
may.
We
are
also
looking
at
pebb
has
the
ability
to
access
the
state's
vaccination
data
as
an
insurer
and
so
to
make
it
easier
on
employees.
C
The
system
can
also
accept
vaccination
data
from
an
outside
source,
so
we're
exploring
that
members
who
have
not
provided
proof
of
the
vaccine
by
the
end
of
open
enrollment
would
be
assessed
the
appropriate
surcharge
on
their
plan
year,
23
premium,
so
that
is
beginning
july
of
2022
as
unvaccinated
employees
become
fully
vaccinated
and
provide
the
proof
to
peb.
The
surcharge
would
be
removed.
C
So
the
recommendations
here
are
to
one
reinstate:
cost,
sharing
for
coveted,
related
treatment
and
hospitalization
and
apply
existing
plan
roles
to
covet
related
treatment
and
hospitalization
claims
effective
january
of
twenty
twenty
two
allow
surveillance
testing
coverage
only
through
pebs
sponsored
vendors
and
three
implement
a
covet
surcharge,
effective,
seven,
one,
twenty
twenty
two
for
all
unvaccinated
primary
members
of
fifty
five
dollars
per
month
per
employee
and
implement
a
175
dollar
a
month
covet
surcharge,
effective
7122
for
unvaccinated
spouses
and
domestic
partners
and
dependents
18
years
of
age
or
older.
A
Okay,
thank
you
for
walking
us
through
that.
I'm
going
to
open
it
up
to
the
board
for
questions
because
I'm
sure
there's
a
lot
of
them,
but
I
want
to
something
you
said
about
page
8
of
the
staff
report
caught
my
ear
and
I
wanted
to
get
it
sort
of
on
the
record
in
that
box.
On
page
18,
we've
got
using
these
assumptions.
We've
got
surcharge
revenue
and
then
of
18.4
million,
and
then
testing
costs
in
the
mid-range
assuming
it's
the
60
test
of
18.5
18.6
million,
so
a
differential
about
150
000
there.
A
But
we
also
heard
that
coveted
treatment
is
a
significant
cost
driver.
You
mentioned
six
out
of
20
of
high
cost
claims,
that's
about
that's
30,
if
I'm
not
mistaken,
so
the
recommendation
is
to
impose
a
surcharge
on
employees
and
unvaccinated
employees
and
unvaccinated
spouses
and
dependents
18
and
older
to
cover
testing
costs
as
anticipated,
because
we
have
a
lot
of
uncertainty,
around
testing
cost
or
is
it
testing
plus
treatment
costs
claims
cost.
C
A
A
A
D
H
For
the
record,
doing
young
policy
director
for
the
office
of
the
governor,
so
first
thank
you,
chair
freed,
and
to
the
board
for
the
opportunity
to
address
the
board
and
answer
questions
directly.
Answering
mr
barnes
question
american
rescue
plans.
Funds
have
been
used
for
the
surveillance
testing
for
the
last
four
months.
The
state
put
in
about
a
20
million
dollar
investment
in
state
employees
to
make
sure
that
one
we
were
being
able
to
function
properly,
have
meetings
such
as
this
and
be
safe
and
secure
our
workforce.
H
H
What
we
know
is
that
the
state
will
continue
investment
through
art
funds
in
standing
up
testing
across
the
state,
because,
as
director
rich
mentioned,
the
biden
plan
has
been
stayed,
but
the
state
is
still
supportive
of
that
and
knows
that
testing
needs
to
spread
in
support
of
many
other
entities,
including
some
small
businesses,
who
may
not
be
able
to
take
this
on,
and
so
there
will
be
a
continued
investment
of
that,
but
we
would
like
to,
as
director
rich
has
pointed
out,
one.
H
It
is
quite
cheaper
for
pep
to
cover
it
than
the
state
through
art
funds
and
for
every
dollar
of
art
funds
that
we
spend
on
these
things.
It's
it's
a
dollar,
that's
taken
away
from
housing,
child
care
and
many
other
initiatives
that
we've
heard
from
the
over
four
thousand
submissions
into
the
every
nevada
recovers
framework
portal.
G
H
Again,
dwayne
young
for
the
record.
That's
a
good
question,
one
other
thing.
One
of
the
reasons
is
the
treasury
guidance
has
not
been
final,
and
so
we
are
waiting
for
the
final
treasury
guidance.
But,
as
you
know,
part
of
during
this
special
session,
it
was
determined
that
the
calculation
of
what
lost
revenue
was.
However,
those
funds
have
since
been
transferred
and
actually
there's
an
ifc
subcommittee.
Today
that
is
overhearing
those
items,
and
so
we
have
recognized
that
one
of
the
things
that
we
have
to
do.
H
I
am
a
14-year
state
employee.
Six
in
this
state,
eight
in
another,
one
state
in
which
I've
only
received
one
raise
my
entire
career,
and
so
one
of
the
things
that
we've
recognized
is
that
we
have
to
do
something
for
state
employees,
particularly
through
the
last
two
years
that
state
employees
have
worked
extremely
hard,
been
flexible
and
sacrificed
many
things
and
has
not
kept.
Our
salaries
have
not
kept
up
with
the
pace
of
the
private
market.
We
know
this.
H
We
have
to
do
this
in
a
way
that
one
is
sustainable
and
does
not
drive
us
to
a
fiscal
cliff,
and
so
the
hesitancy
that
you've
seen
in
our
funds
and
restoring
the
pep
benefits
is
because
we
have
to
be
able
to
understand
when,
where
we're
going
to
be
economically
as
a
state,
we've
seen
the
recovery
of
nevada
and
we've
been
very
cautiously
optimistic,
particularly
in
the
gaming
revenues
being
over
a
billion
each
month
for
the
last
several
months,
and
so
we
hope
that
continues
and
we
hope
that
we're
in
a
better
position.
H
H
Can
we
put
together
for
state
employees
to
entice
them
to
stay,
to
entice
others
to
take
on
a
life
of
state
service
without
putting
the
state
in
a
position?
By
doing
it?
Now,
where
we've
already
closed
the
budget,
to
reopen
it
and
reconsider
restoring
those
benefits,
and
so
I
understand
that
people
need
relief
now,
and
I
hear
that
and
I
I
myself
I
I
look
at
that
situation
and
I
understand
when
I've
had
to
switch
providers.
A
All
right
I,
on
the
other
side
of
the
day,
I
thought
I
saw
a
member
kelly
and
member
aiello-
maybe
remember
karen
so
I'll,
take
remember
kelly's
question
and
then,
after
that,
let's
see
if
you
wish
to
go.
I
Thank
you,
chef,
reed,
okay,
so
I
my
questions.
Don't
specifically
put
you
on
the
spot
anymore.
I
appreciate
your
testimony.
I
guess
what
we've
heard
overwhelmingly
during
public
comment,
though,
is
that
employees
are
being
squeezed.
Now
we
heard
from
a
supervisor
of
employees
that
all
of
his
employees
are
looking
to
leave,
and
so
with
our
by
you
know
with
our
legislative
sessions
that
only
me
every
other
year.
I
What
the
due
diligence
you're
doing
is
costing
is
potentially
all
of
our
high-flying
employees.
So
then,
when
the
state
finally
reinstates
our
compensation
and
benefits
packages,
we've
already
lost
the
good
employees
they're
hard
to
get
back
right.
It's
going
to
be
an
incredibly
competitive
labour
market.
It
already
is
at
inchi
we're
having
trouble
hiring
people
today,
and
so
I
guess
that's
the
challenge
you're
tackling
now,
but
we're
also
tackling
it
every
day
and
we
hear
it
from
employees.
So,
as
I
say,
thank
you
for
talking
about
that.
I
I
just
hope
that
maybe
it
can
be
fast
tracked
a
little
bit
so
that
we
can
keep
keep
our
employees
because
training
and
recruitment
is
an
expensive
endeavor.
So,
thank
you,
okay,
so
I
actually
have
a
question
for
executive
officer
rich
around
just
around
the
I
guess,
more,
focusing
on
the
covert
surcharge.
At
the
moment
you
talked
about
how
this
is
kind
of
to
recoup
costs,
and
so
I
just
wanted
to.
I
wasn't.
I
I
don't
totally
understand
why,
if
we're
doing
this,
not
as
a
punishment
but
to
recoup
actual
costs,
why
would
we
not
have
the
surcharge
apply
to
everybody
who's
unvaccinated,
including
minors,
because
the
vaccine
is
available
to
children
from
12
and
up,
but
also,
why
would
we
exempt
people
with
medical
and
religious
waivers
because
they
still
are
costing
the
plan
right,
they're
still
getting
tested,
they're
still,
potentially
incurring
costs
at
hospital
and
stuff?
So
that's,
that's
really.
My
question.
Thank
you.
C
So
laura
rich
for
the
record,
so
the
recommendation
is
to
not
impose
surcharges
over
for
dependents
under
18.
However,
we
can
certainly
change
that,
if
that's
what
the
board
would
like
to
do
in
as
far
as
your
second
question
and
and
the
ability
to
give
an
option
for
waivers,
that
is
by
law,
something
that
we
would
have
to
do,
that
is
ensures
in
the
definition
of
you
know
how
we
can
and
how
we
can
impose
surcharges.
C
It's
the
reasonable,
lower
rich
for
the
record.
It
is
the
reasonable
alternative
to
the
vaccine.
So
it
is,
you
can
get
vaccinated
and
not
have
the
surcharge,
but
you
have
to
have
a
reasonable
alternative
to
not
receive
the
vaccine
and
not
receive
the
surcharge,
so
that
reasonable
alternative
is
the
medical
exemption
and
that's
why
and
she
has
that
as
well,
not
for
the
same
reason
as
a
health
plan
would,
but
it's
it's
for
similar
reasons.
F
For
the
record,
this
is
betsy
aiello
and
again
I
have
a
question
for
laura
rich
and
my
question
is
just
understanding
one
of
the
sentences.
That
is
how
we
can
allow
to
do
the
surcharge.
This
statement
says,
require
it's:
it's
the
health
contingent
broken
into
two
main
categories.
You
talked
about
and
outcome
based
requiring
a
participant
to
pay
a
higher
premium
to
obtain
or
maintain
a
health
status.
F
I
it's
hard
for
me
to
understand
how
that
higher
premium
would
be
the
surcharge
for
not
unless
it's
to
maintain
not
having.
F
C
C
F
J
Thank
you,
leslie
biddleston,
for
the
record.
I
have
a
question
regarding
the
surveillance
versus
diagnostic
testing
that
member
rich
or
executive
officer
rich
talked
about.
It
seems
very
confusing
that
we
have
had
this
pandemic
for
a
long
time
in
this
virus
for
a
long
time,
and
we
can't
figure
out
what
the
difference
between
surveillance
and
diagnostic
is
and
if
we
can
somehow
have
like
a
surveillance
test
for
those
people
that
are
testing
weekly
that
may
have
costs.
J
C
Laura
rich
for
the
record,
I
can
address
that
so
survey,
so
just
to
to
be
clear,
surveillance
and
diagnostic,
and
I'm
not.
I
can't
say
this
for
sure,
because
I
haven't
seen
the
cost,
but
our
tpa
is
in
the
audience
they
can
confirm.
They
come
in.
Basically,
the
cost
is
a
cost,
regardless
of
you
know
what
kind
of
test
you're
getting.
So
you
know
if
it's
a
rapid
test,
it's
at
one
cost.
If
it's
a
pcr,
it's
at
another
cost
right,
and
so
it's
not.
C
The
cost
is
not
different,
whether
it's
surveillance
or
diagnostic,
the
difference
is
it's
a
code,
it's
how
it's
built,
and
so
the
insurer
has
to.
We
are
federally
mandated
to
pay
at
100
a
claim
that
comes
in
with
a
code
that
is
diagnostic,
whereas
a
surveillance,
we
are
not.
We
so
a
claim
that
comes
in
with
a
code
as
a
surveillance
test.
C
The
insurer
is
not
obligated
to
pay.
The
problem
is
the
provider
community,
and
this
is
something
I've
heard
from
other
health
plans.
You
know
it's
been
confirmed.
Just
you
know,
across
the
board,
from
conversations
I've
had
from
people
in
the
industry.
That
providers
are
largely
billing,
everything
is
diagnostic,
and
so,
when
these
claims
come
in,
insurers
are
obligated
to
pay
these
claims.
So
the
difference
is
not
in
cost.
It's
just
how
it's
billed
and
whether
we're
obligated
to
pay
or
not.
D
Yeah,
thank
you
tom
verducci,
for
the
record.
You
know.
I
wanted
to
point
out
that
when
I
start
my
work
day,
I
I'm
required
when
I
go
out
in
the
field
to
meet
with
anybody.
I
have
to
be
vaccinated
and
I'm
asked
questions
how
I'm
feeling
today,
if
I've
had
any
exposure
and
it's
a
very
effective
way
of
reducing
the
spread
of
covet
19.-
and
you
know,
I
see
that
and
she
has
implemented
vaccine
requirements
and
the
osha
department
of
labor
is
requiring
employees.
D
Employers
with
over
100
employees,
be
vaccinated,
come
january,
4th
and
even
those
pending
litigation.
I
think
that
it
is
required
to
have
some
kind
of
plan
in
place
to
reduce
the
unvaccinated
membership
and
the
exposure
that
the
plan
will
be
paying
with
increased
costs
and
expenses.
So
my
question
would
be
for
mr
young:
what
is
the
state
of
nevada's
plan
with
the
osha
and
department
of
labor
requirements?
Come
january,
4th.
H
Doing
young
for
the
record-
and
I
just
want
to
clarify
yes,
the
the
osha
plan
required
didn't
require
vaccination
required
employees
who
are
either
be
vaccinated
and
they
are
not
vaccinated.
They
be
tested
weekly.
The
only
portion
that
plan,
that
is
a
vaccine
mandate,
is
for
providers
who
build
medicaid
or
medicare
directly
through
the
federal
government.
H
They
must,
and
so
that's
large
health
care
systems.
Hospitals,
a
few
providers
are
exempted,
such
as
schools,
home
and
community-based
providers
and
physician
offices,
but
that
is
a
large
portion
of
the
medical
community
that
has
had
fed
that
has
had
court
challenges
which
have
not
succeeded,
and
so
that
is
still
in
motion
with
the
biden
plan
or
the
osha
plan
being
stayed.
H
The
state
of
nevada
has
already
been
in
compliance.
In
fact,
we
were
one
of
the
leaders
in
the
nation
in
doing
this
by
implementing
our
vaccine
or
testing
policy.
The
difference
between
our
plan
and
the
federal
plan
is
that
we
said
once
a
work
site
achieved.
70
percent
and
70
was
based
on
the
known
available
science
that
we
had
at
the
time
that
moved
us
closer
to
a
hurt.
H
Immunity
we've
since
learned
more
that
that
is
closer,
because
viruses
tend
to
mutate
that
we've
have
we've
seen
and
with
various
variants
as
they
grow
stronger
as
less
people
are
vaccinated,
and
so
we
know
that
that
is
needs
to
move
closer
to
the
90
mark.
And
so
our
policy
said
70
where
we
will
be
moving,
is
all
unvaccinated
employees,
so
those
who
previously
had
not
been
tested
because
their
work
site
had
achieved
that
70
percent
will
now
have
to
be
tested
in
compliance
with
that
plan.
H
And
so
we,
the
white
house
this
morning,
as
I
was
driving
here,
has
announced
new
plans
to
really
push
this.
But
the
focus
is
really
one
get
people
vaccinated.
That
is
the
most
safest
and
effective
way
to
stop
the
spread
of
this
disease
and
for
those
who
medically
cannot
be
vaccinated
or
it
is
against
their
closely
held
religious
beliefs.
H
Then
we
pose
the
alternative,
protect
those
and
everyone
around
you
by
being
tested,
know
your
status
weekly,
we've
had
this
conversation
and
it's
not
any
different
than
what
we've
had
in
public
health
for
years,
whether
it's
stds,
whether
it's
tuberculosis,
whether
it's
chickenpox,
know
your
status,
detect
it
and
protect
everyone
around
you,
and
so
this
conversation
has
not
become
any
different.
H
I
think
some
of
the
politicization
around
this
particular
subject
has
made
it
a
bit
more
intense,
but
when
we
get
to
the
core
of
it,
it's
common
public
safety
measures
and
protections,
and
so
to
to.
In
summary,
to
answer
your
question,
this
state
will
continue
to
lead,
and
so
we
have,
we
will
continue
to
test
unvaccinated
state
employees.
H
What
we
are
asking
you
to
consider
today
is
so
to
help
relieve
some
of
that
burden
on
state
employees
by
covering
it
through
the
plan,
by
doing
that,
by
having
a
surcharge
on
those
who
do
not
choose
to
be
vaccinated,
there
are
many
people
who
feel
strongly
against
being
vaccinated.
H
They
won't
do
it,
and
so,
but
this
is
pandemic,
has
been
shouldered
on
the
burden
of
everyone,
and
now
this
particular
the
testing
should
be
shouldered
on
the
burden
of
those
who
refuse
to
do
so
and
then,
finally,
in
asking
the
the
in
and
asking
all
of
that,
it's
it's
simple:
it's
not
a
punishment,
it's
not
a
retaliation.
H
It's
simply
saying
we
have
to
move
our
state
forward.
We
have
to
reach
the
road
to
endemic.
We
have
to
find
our
way
out
of
this,
and
the
way
out
of
it
is
either
be
vaccinated
and
if
you're
not
vaccinated,
be
testing
and
have
a
way
to
understand
that
you
will
be
surcharged
to
cover
that
testing
at
a
cheaper
cost
than
the
state
taking
child
care
resources,
housing,
resources,
food
security,
resources
to
pay
for
that
testing.
G
Yes,
for
mr
young,
as
I
understand
it,
you
said
that
it's
cheaper
for
pebb
than
for
the
state
to
do
the
surveillance
testing.
Did
I
understand
you
correctly?
Yes,.
G
H
Yes,
it
was
and
that's
why
the
state
put
in
initial
resources,
because
we
wanted
to
protect
the
health
and
safety
of
our
workers,
and
so
the
state
put
in
the
initial
resources
for
testing
to
get
us
there,
but
we
knew
that
it
was
not
long-term
sustainable,
and
so
we
looked
through
other
mechanisms,
such
as
health
plans.
The
same
as
medicaid
covers
it,
the
same
as
culinary
health
plan
would
cover
it
for
their
workers,
and
many
other
private
plans
would
cover
it
that
are
employer-based.
I
I
actually
have
a
question
that
kind
of
switch
switches
the
gears
a
little
bit,
and
I
wanted
to
actually
so
there's
basically
three
recommendations
on
the
table
from
executive
officer
rich
so,
and
I
wanted
to
maybe
run
through
my
notes.
The
first.
I
think
the
first
choice
is
around
the
cost
sharing
or
the
first
vote,
and
so
I'm
one
of
the
statements
you
made
was
that
we,
the
board
either
consider
going
to
the
cost,
sharing
model
effective
january
1st
or
not
going
then
and
then
waiting
until
the
emergency
declaration
ends.
I
That's
kind
of
extreme
right,
because
you're
talking
about
making
a
change
to
our
plans
mid-plan
year,
which
I
have
always
have
issues
with,
couldn't
the
board
choose
to
go
to
the
cost
sharing
model
on
july
1
of
2022,
when
we,
when
our
plans,
update.
I
I
I'm
somewhat
concerned
that
you
still
don't
have
a
process
flushed
out,
so
we're
here
today
talking
about
actually
potentially
putting
in
a
covert
surcharge,
but
we've
really
got
no
idea
how
it
would
work
and
that's
a
concern
to
me
because
I
think
that
process
is
everything
in
health
insurance
and
that's
often
where
participants
get
the
most
frustrated
with
us
is
where
we
outline
outline
kind
of
a
goal,
but
we
don't
have
a
process
flushed
out.
I
So
can
you
talk
a
bit
about
why
we
don't
have
a
process
flushed
out
and
when
you
expect
to
have
that
in
place
so
that
the
board
can
review
it.
C
So
laura
rich
for
the
record
first
I'll
just
say
there
was
a
lot
of
work
and
research
involved
in
just
to
get
us
to
this
point,
and
so
the
work
and
effort
involved
to
to
come
up
with
the
process
will
also
be
a
process
in
itself.
So
we
wanted
to
take
this
in
steps.
It
made
sense
to
take
it
in
steps
not
do
all
the
work,
that's
associated
with
flushing
out
all
the
details
unless
the
board
made
the
decision
to
move
forward
with
us.
C
So
while
we
do
have
high
level
details
in
place,
I've
made
sure
that
our
enrollment
eligibility
system
vendor
can
accommodate
any
of
these
recommendations.
We've
had
all
those
initial
conversations
with
public
health
in
terms
of
getting
the
vaccination
data
we're
already
starting
behind
the
scenes,
but,
for
example,
the
exemption
process
right.
This
is
something
that
pebb
needs
to
work
very
closely
with
the
governor's
office
and
legal
counsel,
to
ensure
that
you
know
the
the
exemption
and
that
waiver
process.
C
We
are
following
the
the
legal
requirements
and
and
really
meeting
the
coordinating
with
the
governor's
office
to
ensure
that
you
know
we're
aligning
in
our
and
our
path
forward.
This
does
not
go
into
place.
It
is
not
implemented
until
july
1,
and
so
we
have
time
to
implement
the
actual
the
details
of
that
process
and
and
move
forward
with
that.
This
is
something
that
I
plan
to
bring
to
the
board
in
january
and
in
march
and
again
in
may
we'll
be
talking
about
this
at
each
board
meeting
moving
forward.
C
So
this
is
it's.
Definitely
as
we
get
more
details
like
I
said
in
the
report,
there's
a
lot
of
initial
data
that
we're
working
with
that
we
have,
but
if
that
data
changes,
we'll
have
to
come
back
to
the
board
with
new
information
and
say,
for
example,
let's
say
that
that
the
5
000
employees,
it
looks
like
now
we're
down
to
3
000..
C
Well
that
changes
costs
that
changes
a
lot
of
criteria,
and
so
we
can
come
back
to
the
board
in
january
or
in
march
and
say
look
maybe
the
175
was
was
too
much.
We
can
probably
bring
it
down
to
you,
know
100
or
whatever
it
is
so.
We
have
time
to
flush
out
the
details,
but
we
need
to
make
a
decision
today
so
that
we
can
move
forward
with
the
the
actual
plan
itself
and
start
with
the
implementation
and
move
forward
with
those
things.
F
This
is
betsy
aiello
and
again
this
is
for
executive
officer
rich.
I
I'm
going
back
on
to
something
michelle
had
just
mentioned,
and
that
has
to
do
with
restoring
cost
sharing
for
covid,
19
and
and
the
date
possibly
to
start
or
not
start
actually,
the
by
the
board,
not
imposing
cost
sharing
on
covid.
F
We
are
actually
operating
outside
our
current
plan
design,
correct,
because
the
plan
design
itself
requires
cost
sharing
for
certain
things,
and
we
just
said
in
a
boat
oops,
I'm
sorry,
I'm
italian.
I
have
to
use
my
hands
in
a
boat,
we
decided
we
were
going
to
operate
outside
the
current
plan
and
then
you
also
said
that
when,
because
of
some
things,
the
federal
government
had
said
at
one
time
too,
and
we
decided
to
like
to
do
it,
but
our
health
plan,
such
as
our
hmo,
did
that
for
a
while
and
they've
reversed
it.
F
So
our
own
programs
are
a
bit
operating
and
discon
disaccord.
Also,
I
think
so.
I
just
wanted
to
get
to
get
back
to
that,
because
it's
not
really
a
planned
design
change,
it's
implementing
something
though
people
maybe
have
gotten
used
to
it,
though
my
guess
would
be
that
if
you
haven't
had
covet
and
been
in
the
hospital,
you
may
not
even
realize
that
the
plan
is
paying
a
hundred
percent
because
you
haven't
experienced.
C
Correct
and
laura
rich
for
the
record
it
is
it
was.
It
was
a
change
that
was
made
in
mid-year
when
we
made
this
exception
to
the
covet.
Cost
sharing
so
covet
is
treated
differently
than
any
other
disease
today
in
the
cost-sharing
aspect,
and
so
it
was
done
mid-year.
It
is
something
we
can
change
mid-year.
It
is
something
we
can
change.
You
know
in
july.
If
that's
what
the
board
would
like
to
do.
C
The
recommendation
is
january
of
2022
because,
as
you
said,
we
already
have
a
misalignment
within
our
plans
because
the
fully
funded
or
the
fully
insured
hmo
plan
those
members
are
not
receiving
so
they're
they're,
paying
cost
sharing
for
any
coveted
related
treatment,
whereas
those
on
the
self-funded
plan
are
not
subject
to
it,
and
we
are
also,
with
the
exception
of
the
state
of
hawaii,
one
of
the
only
public
sector
health
plans
that
has
not
reinstated
cost-sharing
for
cobit.
I
Can
I
just
ask
a
very
quick
follow-up
on
that
then
so
so
I
hear
what
you
say
so
just
one
clarifying
point
so
covet
is
not
discussed
in
the
planned
document
and
there's
no
reference
to
the
differential
treatment
of
coven
in
the
planned
document.
C
A
This
is
laura
freed.
That's
not
my
recollection
that
we
changed
the
mpd
for
to
account
for
coven,
and
you
know
I
have
to
say
here
I
piling
on
what
betsy
had
to
say.
I
don't
really
enjoy
the
idea
that
we
would
treat
participants.
A
You
know
who
do
the
same
job
in
the
south
and
who
are
a
member
of
the
hpn.
Hmo
has
to
pay
cost
sharing
if
they
contract
covid,
as
opposed
to
somebody
in
the
north,
in
the
same
job
class,
making
the
same
money
who
gets
their
claims
paid
at
100,
and
that
is
why
I'm
in
favor
of
reinstating
cost
sharing
to
treat
code
like
any
other
disease,
but
anyway
I'll
leave
it
to
other
members
with
questions.
C
For
the
record,
so
I
have
a
quick
question
regarding
testing.
So
if
we
chose
option
two
to
provide
coverage.
C
It
would
still
allow
for
a
loophole
right,
so
I
guess
this
question
is
for
laura
rich,
so
you
could
still
go
anywhere
and
say
you
had
symptoms
and,
and
that
would
generate
higher
cost
correct,
correct,
so
laura
rich
for
the
record.
So
let's
say
that
an
employer
decided
to
push
the
cost
on
to
the
employees
and
an
employee
was
subject
to
you
know.
Let's
say
fifty
dollars
a
week
to
to
be
tested.
C
The
the
loophole
here
is
that
insurers
are
required
to
to
pay
for
at
a
hundred
percent
a
test
that
is,
that
is
a
diagnostic
test
and
so
playing.
You
know.
Devil's
advocate,
I'm
a
I'm,
a
unvaccinated
employee
who
is
subject
to
weekly
testing,
and
I
know
that
I
have
to
pay
fifty
dollars
a
week
to
test
and
through
for
through
my
employer.
But
I
know
that
if
I
show
up
at
the
nearest
cvs
and
cough
and
say
I've
got
symptoms,
it's
paid
at
100
for
free.
C
C
So
that's
that's
the
problem.
There
is
that
until
industry-wide
we
can
figure
out
and
maybe
cms
is
going
to
potentially
come
out
with
much
more
stringent
or
clear
guidance
on
the
definitions
of
surveillance
and
and
diagnostic
testing,
but
we're
not
there.
Yet
everyone
is
every.
The
providers
across
the
board
are
billing,
as
diagnosed
or
as
as
diagnostic
and
not
surveillance.
F
Betsy
aiello
for
the
record
again
executive
officer
rich,
so
the
question
that
I
have
is
that
I
I
understand
where
that
that
could
happen,
and
over
time
there
might
be
some
development
of
surveillance,
but
by
doing
an
option
too,
it
would
build
a
process
from
what
I
understand
that
you
said
and
also
mr
young,
that
we
might
be
paying
sixty
dollars
a
test
instead
of
a
hundred
and
thirty
dollars
a
test,
and
I,
as
an
employee
that
had
to
be
tested
if
I'm
not
vaccinated,
it
would
be
a
whole
lot
easier
for
me
to
go
to
the
site
right
near
my
employer.
F
C
Laura
bridge
for
the
record
correct
we're
actually
exploring
a
very
viable
option,
which
is
using
a
telemedicine
provider
where
we
have
actual
physical
tests
where
we
can
that
we
can
distribute
or
mail
to
the
employees
and
they
using
a
telemedicine
provider
that
is
virtual
on
their
phone.
They
self-administer
the
test.
They
the
screener
on
the
other
end,
will
then
log
the
results
in
and
so
state
staff
have
the
ability
to
see.
Okay,
this
person
tested
and
is
negative,
and
so
we
have.
We
will
have
that
information.
C
So
that's,
even
you
know
you
don't
even
have
to
show
up
anywhere
you've
got
to
test
that
you
can
self-administer
at
home.
So
yes,
and
that's
exactly
what
we're
saying
it's,
you
know
about
a
33-ish
dollar
option
for
those
tests,
and
so
we
can
by
offering
that
we
can
control
costs.
We
can
contain
those
costs
and
steer
members
into
using
that,
instead
of
using
the
hundred
and
thirty
dollar
option
or
or
even
more
expensive,
if
you
go
through
urgent
care
or
something
like
that,.
D
Yes,
tom
verducci,
for
the
record:
do
we
know
what
the
associated
cost
would
be
with
for
exemption
requests
as
well
as
vaccine
documentation,
and
what
the
process
would
be
to
review
the
vaccine
documentation?
Is
there
a
process
in
place.
C
Laura
rich
for
the
record,
pebb
is
actually
looking
at
that
we
are
working
with
the
division
of
public
and
behavioral
health
to
potentially
access
the
vaccine
data.
That
is
that
the
state
already
has
access
to,
and
so
insurers
already
do
get
that
as
well
as
other
organizations
and
entities
that
have
been
granted
access
through
statute.
C
You
know
to
to
access
that
information,
so
we
are,
we
would
be
getting
that
hopefully
electronically
anyway.
Now
that's
just
state
data
right.
So
if
you've
received
your
vaccination
say
in
texas,
then
we
don't
have
that
and
so
those
members
that
we
wouldn't
have
access
to
their.
You
know
their
state
vaccine
data.
Then
we
would
allow
them
to
upload
through
the
eligibility
and
enrollment
system
vendor
they
would
upload
their
vaccine
card.
You
know
just
like
they
upload
their
birth
certificate
or
their
marriage
certificate
when
they
enroll
into
pebb
and
they
enroll
their.
C
C
Rich
for
the
record,
no,
that
is,
that
is
built
into
the
eligibility
and
enrollment
system,
and
we
have
that
ability
to.
You
know
it
sounds
like
again
we're
transitioning
to
a
new
vendor
on
january
1st,
and
so
this
is
a
new
vendor.
But
it
sounds
like
it's
part
of
that
system,
and
just
you
know
something
that
can
be
just
turned
on
and
it's
a
function
of
the
system.
I
C
Laura
rich
for
the
record,
we
are
already
exploring
those
options.
We've
had
a
lot
of
conversations
already.
It
sounds
like
there's
a
several
week
runway
for
that,
but
we
expect,
because
it
is
through
existing
vendors
that
we
have
in
place
already.
C
I
And-
and
I'm
not
sure
sorry,
michelle
kelly
for
the
record-
is
I'm
not
sure
who
this
question
is
addressed
to,
but
is
there
a
required
process
for
notifying
employees
around
kind
of
if
we
start
to
limit
the
vendors
you
know,
I
know
that
they're
used
to
having
on-site
right
now,
but
they're
also
used
to
being
able
to
go
to
cvs
and
stuff.
So
is
there
a
30
day
or
60
day
notice
period
that
we
anticipate.
C
We
would
definite
laura
ridge
for
the
record.
We
would
definitely
be
communicating
this
not
just
through
pebb,
through
the
department
of
administration
through
the
governor's
office,
we're
also
working
very
closely
with
the
nevada
system
of
higher
education,
who
is
not
part
of
the
state
process.
In
terms
of
you
know
the
the
on-site
testing
that
we've
provided
for
state
employees,
but
moving
forward
because
they
are
part
of
the
pebb
system.
I've
been
working
very
closely
with
them
as
well
to
to
secure
options
through
the
university
system
as
well,
and
so
so
yeah.
So
we
are.
C
We
would
be
communicating
this
as
much
as
possible
again
we're
looking
at
you
know,
potentially
being
able
to
mail
these
tests,
people's
houses
or
distribute
them
through
the
workplace,
and
so
I
think
this
is
going
to
be
a
coordinated
effort
between
agencies
between
you
know
the
state
and
the
university
system.
You
know
so
there's
there's
going
to
be
a
lot
of
communication.
That's
going
to
need
to
happen.
A
C
G
Okay,
because
that
was
my
concern-
that
if
it
is
a
change
of
coverage,
it
couldn't
be
done
by
january
one
and
so
we're
sure
it's
not
a
change
of
coverage,
then.
C
C
And
I
do
have
to
say
laura
ridge
for
the
record.
I
did
receive
a
response.
Member
kelly,
I
have
actually
a
former
staff
member
text
me
just
now
and
say
that,
yes,
it
is
the
coven
19
cost
sharing
is
specifically
in
the
master
plan
document
for
for
this
year.
Yes,.
C
To
clarify
yes,
laura
rich
for
the
record,
it
was
updated
this
plan
year
to
ensure
that
that
was.
That
was
something
that
was
covered
in
the
planned
document.
Yes,.
F
C
So
laura
rich
for
the
record,
the
master
plan
document
applies
to
our
self-funded
plans,
and
so
each
self-funded
plan
has
their.
It
has
its
own
master
plan
document
the
fully
insured
hmo
product
does
it
does
not
fall
under
the
the
requirements
of
the
you
know
the
master
plan
they
have
their
own
master
plan
document.
I
C
I
B
A
A
So
the
question
is:
can
the
board
decide
if
it
chooses
to
reinstate
cost
sharing
is
january
1st
2022
too
soon,
because
there
is
a
30-day
notice
to
change
the
provisions
of
the
plan.
So
would
we
have
to
push
it
out.
B
A
B
A
G
B
Thorlton
hpn
for
the
record
just
got
a
text.
I
was
waiting
to
confirm.
We
did
not
change
the
fully
insured
certificate
of
coverage
when
we
made
that
provision
change,
we
knew
it
was
somewhat
of
a
temporary
adjustment
to
that
plan
to
waive
those
those
flat
co-payments
for
inpatient,
outpatient
treatments
of
covid,
so
the
planned
document
or
the
you
know
in
the
case
of
a
fully
insured
plan,
the
certificate
of
coverage
was
not
amended
and
then
again,
when
we
reverted
back
to
applying
those
co-payments,
it
was
also
not
not
adjusted.
B
So
it
was
simply
an
administrative
adjustment
that
was
made
to
to
make
that
change
and
that
accommodation.
A
I
I
If
I
would
argue
that,
potentially
we
have
even
one
member
out
there
who
did
that
and
if
we
are
going
to
change
that
coverage
even
with
notice,
we
need
to
open
enrollment
again
to
allow
them
to
select
a
plan
that
better
suits
their
needs,
because
that
is
the
purpose
of
open
enrollment
is
to
give
people
an
opportunity.
I
So
I
think
anyway,
I'm
pro
cost
sharing.
I
just
am
concerned
about
the
procedure
because
it's
my
understanding
we're
obligated
to
operate
our
plan
in
line
with
our
planned
document,
so.
A
This
is
laura
free.
I
guess
that
would
mean
that
member
would
have
to
be
sitting
there
in
may
and
thinking
who
covers
covid
and
how
many
you
know
and
am
I
going
to
get
covered,
and
I
don't
know
that
anybody
sits
around
thinking,
I'm
going
to
make
a
decision
based
on
whether
I
get
a
covet
case
or
not.
G
Yes
for
miss
rich,
if
it's
determined
that
we
need
additional
vaccines
over
and
above
what
we
have
now
with
the
new
variants
emerging
emerging
and
that
sort
of
thing
will
pebb
need
to
implement
additional
surcharges.
If
we
do
need
additional
vaccines.
C
Laura
rich
for
the
record
at
this
time,
that's
not
being
considered
it's
something
that
the
board
can
definitely
consider
in
the
future.
It's
something
that
you
know
the
governor's
office
can
work
with
pep
on.
But
at
this
point
that's
not
something
that
we
are
considering.
D
Yes,
tom
verducci
for
the
record:
are
there
any
other
states?
We
may
have
discussed
this
that
are
using
a
covid
surcharge,
or
would
we
be
the
only
one
out
there.
C
Laura
rich
for
the
record,
we
obviously
have
not
checked
with
every
single
state.
We
did
reach
out
to
a
resource
that
we
have,
that
that
does
distribute
emails
to
different
public
entities,
and
we've
received
a
lot
of
responses
from
public
sector
health
plans
that
were
very,
very
interested
but
had
not
implemented.
Yet
they
were
looking
at
it,
but
they
had
not
implemented.
C
Yet
there
was
one
public
sector
health
plan,
a
small
one
in
smallish,
one
in
dallas
that
did
implement
a
surcharge
and
they
actually
went
above
and
beyond
and
implemented
some
incentives
as
well,
provided
you
know
two
extra
days
off
for
those
who
got
had
gotten
vaccinated
and
you
know
so.
They
took
some
extra
steps
on
top
of
that.
So
we
do
know
of
public
sector
plans
that
have
done
it,
but
this
has
been
more
common
in
the
private
sector
among
large
employers.
C
So
like
delta
and
boeing-
and
you
know
several
large
employers
like
that.
D
Okay,
so
tom
verduce
for
the
record,
so
we
would
be
the
only
state
that
would
actually
be
implementing
coveted
surcharges.
D
And
you
know
from
a
risk
management
perspective,
liability
and
unintended
consequences,
especially
that
175
dollar.
D
Family
charge-
and
you
know
the
state
employees
have
been
have
hit
very
hard
with
no
raises
over
a
number
of
years,
and
I
think
of
the
soul
out
in
the
love
lock
working
for
the
department
of
corrections
is
paying
800
a
month
in
a
trailer
with
three
kids.
I
have
a
hard
time
with
this
one.
I
I
really
do,
and
I
just
wanted
to
pass
on
my
personal
comments,
no
question
there.
D
A
Thank
you,
mr
verducci.
All
right,
I'm
not
seeing
a
lot
more
questions
raised.
Hands
looks
like
we're
all
discussed
out
so
feels
like
it's
decision
time.
My
friends.
A
So
all
right,
knowing
what
we
know
that
the
plan
has
to
provide
notice.
I
think
I'm
gonna
do
this.
I'm
gonna
do
this
in
chunks,
and
so
I'd
like
to
tackle
recommendation
one
first
reinstate
cost,
sharing
for
covert
related
treatment
and
hospitalization
and
apply
existing
plan
rules.
That
is
the
normal
master
plan
document
for
the
cdhp
related
to
covered
related
treatment
and
hospitalization
claims
effective.
A
J
Leslie
biddleston
for
the
record.
I
support
pushing
it
out
to
march
1st
of
2022,
which
would
give
staff
60
days
to
notify.
J
A
Okay,
so
our
second
linda
fox
for
the
record,
I
will
second
that
motion
okay.
Thank
you
all
right,
it's
been
moved
and
seconded
to
reinstate
cost,
sharing
for
covert
related
treatment
and
hospitalization
for
the
cdhp
effective
march,
1st
of
2022.,
all
in
favor,
say
aye.
A
A
Two
three
and
four:
let's
take
number
two
pebre
pep
staff
recommends
allowing
surveillance
testing
coverage
only
through
pebb-sponsored
vendors.
That
is
only
covered
if
you
go
through
the
vendor
that
has
ultimately
worked
out
between
peb
staff
and
our
our
medical
vendors
or
our
pharmacy
benefit
manager
board
members.
Do
you
have
a
sense
of
your
your
direction
on
that
I'll?
Make
that
motion
all
right?
Thank
you,
member
kelly.
Is
there
a
second
to
that
motion,
linda
fox,
for
the
record
I'll?
Second
that
motion?
Okay?
Thank
you
all
right.
A
So
it's
been
moved
and
seconded
to
allow
surveillance
testing
coverage
only
through
pub
sponsored
vendors
board
members,
all
in
favor
signify
by
saying
aye
aye
aye
any
opposed
a
all
right.
Thank
you.
Motion
carries
all
right
here.
It
is
friends,
implement
number
three
implement
a
coveted
surcharge,
effective
july
1st
of
2022
so
effective
in
plan
year,
23
for
all
unvaccinated
primary
members
of
pebb
of
55
a
month
per
employee.
D
Well,
tom
verducci
for
the
record
I'll
be
voting
no
on
this
one.
B
Record
I
will
make
that
motion
that
we
implement
the
55
surcharge.
A
Okay,
the
record
will
reflect
mr
barnes
and
mr
verducci's
nays
motion
carries.
A
Last
but
not
least,
the
motion
or
excuse
me
emotion,
geez.
The
recommendation
is
to
implement
a
175
dollar
a
month,
coveted
surcharge,
effective,
again
july,
1st
2022
so
pure
plan
year,
23
for
unvaccinated
spouses,
domestic
partners
and
dependents,
18
or
older,
and
to
this
given
the
uncertainty
of
testing
costs.
A
But
that's
my
own
personal
feeling,
so
board
members
sense
of
the
board.
A
Right,
thank
you.
Is
there
a
second
lesson
april,
2nd,
okay,
oh
okay,
I'll
take
miss
caron,
she
hasn't
got
a.
She
hasn't
got
a
second,
yet
all
right,
all
right
board.
Members,
you've
heard
the
motion
implement
175
a
month
covet
surcharge,
effective
july
1st
2022
for
unvaccinated
spouses,
domestic
partners,
independents,
18
or
older,
with
approval
to
peb
staff
to
lower
that
surcharge.
If
testing
costs
prove
to
be
lower
for
the
plan,
all
those
in
favor
say
aye.
A
Any
opposed,
say,
nay,
nay,
all
right.
The
record
will
reflect
mr
verducci,
mr
barnes's
nays
motion
carries.
Thank
you,
everybody
with
that.
We
will
move
to
agenda
item
seven.
Take
a
break!
Oh
I'm!
Sorry!
Yes,
of
course
we
can
take
a
break.
Let's
take
it
sorry
guys
you
always
have
to
remind
whether
we're
virtual
or
we're
not
virtual,
but
you
guys
can
always
go
to
the
bathroom,
no
matter
what
since
we're
in
person.
But
yes,
let's
come
back
at
10
55.,
it's
10
47
now.
A
All
right,
ladies
and
gentlemen,
I
will
call
this
meeting
of
the
pet
board
back
to
order.
C
All
right
for
the
record,
laura
rich,
just
to
give
a
little
background
on
this.
At
the
september
30th
board
meeting
anne
had
presented
information
regarding
planned
trend
and
the
impact
of
covid
and
recommendations
related
to
pebb's
differential
cash
levels.
C
Anne's
original
recommendation
expected,
after
all
the
expected
trend
and
required
expenditures
such
as
the
medicare
hra
funding
and
premium
buy
downs.
We
were
exp.
The
the
recommendation
by
anne
was
to
use
12
million
dollars
in
differential
cash,
so
the
board
later
approved
that
the
12
million
dollars
be
used
to
develop
plan
design
that
could
be
funded
over
three
years,
with
a
primary
focus
of
restoring
deductibles
and
out-of-pocket
maximums.
C
C
So,
after
factoring
in
additional
crf
dollars-
and
let
me
go
back
since
we
have
not-
we
have
not
discussed
or
we've
took
some
items
out
of
out
of
order,
but
we
are
getting
additional
crf
money
from
cares,
act
funding
from
on
the
ifc
agenda
on
in
december,
in
addition
to
the
five
million
dollars
that
we
received
last
ifc
as
well.
So
with
those
crf
dollars
the
recommendation,
it
has
increased
from
12
million
to
approximately
26
million,
because
some
of
the
contracts
such
as
the
pbm
they
have
not
been
finalized.
C
Yet
approximate
savings
were
used,
so
it's
were
not
necessarily
completely
on
target
because
we
don't
know
about
some
of
these.
We
know
that
there's
going
to
be
savings,
we
just
don't
know
how
much
because
they
haven't
been
awarded
yet
so
some
of
this
was
some
of
these
approximate
savings
were
used
in
this
figure
and
so
depending
on
the
outcome
of
the
final
negotiated
contracts.
This
may
and
this
may
impact
the
actual
savings.
And
what
are
you
know?
C
So
on
page
two,
you
can
see
that
the
there's
a
chart
there
that
shows
trend,
and
I
think
it's
a
very
good
visual
example
of
trend
and
for
those
of
you
who
I
actually
have
a
black
and
white
copy
as
well.
But
if
you
see,
I
think
it's
a
green
line
right
on
page
two
page,
so
this
chart
right
here.
So
on
page
two,
I
believe
it's
a
green
line,
and
that
is
the
the
total
trend,
so
that
is
medical
and
rx
combined.
C
So
you
can
see
that
the
black
line
there
in
the
middle
the
fairly
flat
line-
that's
our
budgeted.
That's
that's
what
what
we
have
budgeted
for.
Overall,
that's
what
the
plan
has
received
in
you
know
in
our
legislatively
approved
budget
and
the
costs
there
are
that
green
line
is
what
is
actually
happening
in
the
plan
right.
So
you
can
see
that
in
2020
you
can
see
those
suppressions.
C
You
can
see
that
it
just
like
it
dipped
down,
and
we
this
is
where
a
lot
of
our
excess
reserves
our
differential
cash
have
been,
has
come
from,
because
people
were
not
going
to
see
their
providers.
They
were
not
saying
they're,
they
were
not
going
to
the
dentist.
They
were
not
seeking
care
in
general
because
of
the
shutdown.
So
we
have
those
suppression
that
suppression
in
2020,
and
then
we've
been
talking
about
this
spike
in
claims,
this
comeback
right.
C
So
all
those
all
those
folks
that
didn't
go
to
the
doctor
are
now
seeking
services,
and
so
you
can
see
that
there's
a
spiking
claims
and-
and
this
is
happening
so
the
differential
here
is
between
the
black
line
and
the
green
line.
This
is
what
we're
missing,
and
this
is
the
reason
why
we
cannot
use
up
all
of
the
excess
we
have
to
have
that,
that
bucket
of
money
to
to
really
take
into
consideration
the
difference
between
the
black
line
and
the
green
line.
C
So
I
thought
that
that
chart
there
just
really
did
a
good
example
of
illustrating
the
the
impact
of
covet,
because
it
highlights
the
claim,
suppression
and
the
beginning
of
that
anticipated
spike.
We
don't
know
how
long
that
spike
is
going
to
last,
and
you
know
what
that
is
going
to
look
like
moving
forward.
C
So
this
is
why
the
entire
the
entire
amount
of
the
the
our
ex
excess
reserves
or
differential
cash
is
not
being
recommended
to
use
so
with
the
assistance
of
aeon,
and
we
do
have
the
aeon
team
here
in
front
of
us.
C
They
have.
We
have
staff
and
ann
have
come
up
with
some
plan
design
options
that
used
a
couple
different
approaches
so
in
option
one.
The
plan
design
basically
takes
a
very
conservative
approach,
so
we're
looking
at
our
recommendation
is:
let's
use
26
million
dollars
in
in
access
cash
in
differential
cash
and
this
plan
design
is
this
option.
One
is
using
21.7
million
in
differential
cash.
So
if
you
look
at
the
plan
design,
the
focus
here
is
on
the
reduction
of
deductibles
and
out-of-pocket
maxes,
just
as
the
board
had
had
decided
on
at
the
last
board.
C
Meeting
so
there
were
a
few
reductions
there
in
deductibles
out
of
pocket
max's
and
then
on
the
ep
on
hmo.
You
know
there
were
some
changes
there
in
the
copays
as
well
so
and
if
I'm
going
to
pull
up
my
colored
copy,
just
really
quick,
because
that
way
I
can
see.
C
All
right
and
so
in
option
two.
The
plan
design
takes
the
moderate
approach
and
that's
where
we
are
using
approximately
26
million
dollars,
which
is
what
staff
feels
comfortable
recommending
in
terms
of
how
much
of
that
differential
cash
we
feel
is
a
safe
amount
to
use,
and
in
this
option
you
can
see
that
those
deductibles
and
out-of-pocket
maxes
are
reduced
a
little
bit
more
you're.
Looking
at
you
know
different
co-pays
on
your
epo
and
hmo,
and
the
the
cost
sharing
as
well
for
rx,
so
that
uses
26
million
dollars
and
then
option
three.
C
The
plan
design
here
takes
a
more
liberal
approach,
so
here
we're
using
more
than
what
staff
is
recommending
that
we
feel
comfortable
with
we're
using
34
million
instead
of
that
26
million
in
differential
cash
and
what
this
plan
does.
Is
it
restores
plan
designed
back
to
pre
pandemic
levels
as
close
as
possible,
because
if
you
recall
the
low
deductible
plan
was
introduced
in
plein
year
22
and
so
the
low
deductible
plan
did
not
exist
pretty
pandemic
and
because
you've
got
to
space
out
the
actuarial
values
between
the
three
plans.
C
You
don't
want
three
plans
that
are
exactly
the
same.
We
had
to
kind
of
tweak
the
the
plan
design
a
little
bit
to
closely
mirror
that
pre-pandemic
benefit
level
by
adjusting
for
the
copay
plan
design
as
well,
and
so
in
this
plan
design.
Here
we
do
have
you
know
again,
the
restoration
of
the
deductible
back
down
to
fifteen
hundred
and
three
thousand
for
the
cdhp,
the
copay
at
zero
for
the
low
deductible
plan.
The
epo
is
at
zero
as
well,
and
we've
adjusted
those
out-of-pocket
maximums
as
well.
C
So
there
are
some
options
here.
We
also,
after
speaking
to
some
board
members.
We
came
back
and
what
we
did
was
kind
of
tweak
some
of
these
plan
designs,
and
so
that
is
the
amend
amendment
that
was
distributed
yesterday,
and
so
you
can
see
that
there's
some
options
there,
where
instead
of
an
option
two
we
are
we're
keeping
the
co-pay
pretty
low
on
the
deductible,
but
we're
making
that
hmo
and
epo
zero
dollars.
C
We've
also
looked
at
some
other
options
right
and
so
those
those
alternatives
are
alternatives
to
option
two
and
three
for
for
those
plant
designs.
So
keep
in
mind
that
a
lot
of
this
you
know
obviously
there's
a
lot
of
contracts
that
are
out
there
right
now.
There's
a
lot
of
volatility
within
our
plan.
C
We
do
feel
as
staff
with
the
recommendation
again
of
the
aeon
team
that
26
million
dollars
we
feel
pretty
comfortable
with
that
amount
going
over.
That
is
we're
not
quite
ready
to
to
recommend
going
over
that
amount
to
restore
plan
design,
because
we
don't
know
what
it's
going
to
look
like.
We
don't
know
what
costs
are
going
to
look
like
what
covid
costs
are
going
to
look
like
with
a
spike
is
when
that
is
going
to
end
right,
and
you
know
what
medical
trend
is
going
to
look
like
moving
forward.
C
So
those
are
all
options
to
consider.
The
other
thing,
too,
is
that
the
board
also
must
have
to
remind
the
board
that,
regardless
of
the
recommendation
that
or
what
is
the
action
that
is
taken
today,
it
will
require
the
approval
of
the
interim
finance
committee,
because
this
is
using
differential.
Cash
to
fund
benefit
plan
restoration,
and
so
this
will
need
to
be
brought
back
to
ifc
for
final
approval
by
the
legislature.
So
with
that
I
will
take
questions.
C
I
think
that
there's
we
also
have
the
aon
team
here:
who's
ready
to
answer
questions
as
well,
so
I'll
leave
it
at
that.
A
A
This
report
is
giving
us
options
to
increase
that
for
option
two.
It
would
be
about
8.6
million
dollars
per
year
and
option
three
would
be
about
11
million
dollars
per
year
over
three,
the
three
upcoming
fiscal
years.
G
C
We
might
not
even
be
having
this
discussion
today
because
we
would
have
to
allocate
other
funding
for
those
testing
costs,
and
so
so
it
shouldn't
affect
it
now.
That
being
said,
you
know
we
don't
know
what
the
future
looks
like
and
so
there's
there's
definitely
room
to
potentially
next
year
to
reassess
right,
so
we're
making
a
three-year
decision
here,
because
we
don't
want
to
apply
all
of
the
funding
to
one
year
and
this
fiscal
cliff
that
you
keep
hearing
about
so
so
we're
spreading
it
out
between
three
years.
C
K
Correct
we
did
not
as
colleen
huber
for
the
record
with
a
on
consulting
correct.
We
did
not
include
additional
surveillance,
surveillance,
testing
or
surcharges
into
our
excess
capital
reserve
level.
F
Betsy
aiello
for
the
record-
and
you
had
mentioned
then
that
option
three
was
about
11
million
of
differential
cash
in
each
of
three
years,
but
some
of
that
would
have
been
the
cfr
dollars
and
the
savings
also
correct.
So
it
isn't
quite
that
much
in
differential
cash.
A
The
coronavirus
relief
that
we're
going
to
get
coming
up
at
ifc,
I
expect,
is
being
used
in
in
this
plan
year
22
and
after
that
I
mean
you
can't
get
crf
after
december
30th.
I
believe
it
is
so
this
is
I
mean
we
don't
expect
to
get
any
other
federal
money
for
covet
claims
in
23
and
beyond,
but
I'll.
Let
laura
speak
to
that
more
in
more
detail.
C
Laura
rich
for
the
record
so
right,
so
the
the
crf
funds
that
we're
receiving
are
specifically
to
be
reimbursed
for
coveted
claims
that
have
already
been
incurred
right,
and
so
those
claims
are
through
the
end
of
december
31st,
so
the
end
of
the
year
december
31st,
and
so
this
that
crf
money
that
we
are
receiving,
although
it's
being
factored
into
the
overall
picture
here,
it's
because
the
plan
is
receiving
the
money
and
it
is
being
allocated
directly
towards
those
claims.
C
But
as
it
you
know
downstream
effects
right.
It's
still
it's
money
that
the
plan
didn't
spend
on
those
claims,
because
we've
been
we've
been
reimbursed
through
crf,
and
so
it
adds
to
the
potential
differential
cash
that
we've
got
to
play
with
at
the
end
of
the
year.
F
So
this
is
betsy
again,
so
my
question
is
because
I'm
trying
to
figure
out
the
the
trend
is
not
accounted
for
before
between
five
and
fifteen
percent.
So
at
least
that's
my
understanding
and
then
we're
taking
differential
money
and
spending
it
either
in
one
two
or
three:
how
much
money
do
we
have
that
is
differential
or
we're
planning
to
do
between
the
five
and
15
or
five
and
ten?
If
it's
that,
because
I'm
thinking
we
have
some
money,
we're
planning
there
for
the
added
claims,
or
am
I
off
thinking
here.
K
Okay,
colleen
huber
for
the
record
with
aeon,
so
you
are
correct.
We
have
in
our.
If
you
look
go
back
to
the
trend,
it
is
peaking
at
that
12
percent
right
now,
but
we
don't
expect
that
to
continue.
The
12
is
really
coming
off
of
where
the
year
prior,
the
claims
were
suppressed
so
dramatically
because
of
covid.
So
when
we
were
expecting
over
time
and
through
the
end
of
plan
year,
22
for
trend
levels
to
return
back
to
normal
or
historical
levels.
K
So
that's
where
our
we
went
back
after
the
last
board
meet
meeting
analyze.
All
of
your
claims
use
as
much
information
as
we
had
at
that
point.
Looked
at
historical
trend
levels
and
what
the
current
trend
levels
are
today,
realizing
that
the
prior
year
the
claims
were
suppressed.
We
don't
expect
to
see
12
percent
through
the
end
of
july
of
22.,
so
as
it
returns
back
to
normal
levels.
What
do
we
project
as
of
june
30th
2022?
K
What
will
the
excess
surplus
be
at
that
point
and
then
to
laura's
point?
Then
we
factored
in
the
the
any
available
the
funding
that
was
received
during
this
plan
year
or
this
calendar
year,
as
well
as
what
we
knew
at
that
point
as
far
as
contract
savings
as
a
result
of
the
procurements
going
on.
Does
that
answer
your
question.
F
K
The
26th,
the
two
so
at
as
of
june
30th
2022
we're
expecting
the
excess
calling
heber
for
the
record.
Sorry
at
the
end
of
june
30th
2022
we're
expecting
your
excess
surplus
to
be
26
million
dollars.
If
we
were
to
spend
that
surplus
over
a
three-year
period,
that
would
be
option
two.
A
A
Based
on
incurred
claims
normalized
for
claims
suppression
due
to
cova
19
trended
to
plan
year,
2023
based
on
a
5
medical
and
8
percent,
prescription
trend.
So
this
was
done.
This
was
projected
based
on
five
and
eight
for
the
next
three
fiscal
years,
calling
heber
for
the
record.
K
D
Yes,
tom
bernice
for
the
record.
So
what
I
understand
laura
rich,
had
mentioned
that
the
anything
that's
approved
here
has
to
go
before
the
ifc.
The
gfo
is
that
right.
So
let's
say
we
went
back
to
our
july
motion
to
restore
the
benefits
to
the
pre-pandemic
levels
and
see
we
did
suggest
an
option
three
but
say
it
was
cost
prohibitive
from
the
ifc
and
gfo.
D
C
Laura
rich
for
the
record:
it's
certainly
something
that
the
board
an
action
item
that
the
board
can
take
the.
Perhaps
the
board
can
vote
on,
let's
say:
option:
three:
should
it
not
get
approved,
then
we
revert
to
option
two.
C
But
again
this
all
would
have
to
go
through
through
ifc
and
it's
a
good
question.
I
don't
know
because
we
don't
have
a
long
runway
and
we
do
need
to
be
able
to
price
out
the
plans
in
march
and
so
aeon
needs
to
understand
what
that
plan
design
looks
like
by
february
in
order
to
come
to
the
march
board
meeting
and
be
prepared
for
rate
setting,
and
so
we
don't
have
a
lot
of
room
and
timing
for
that,
especially
given
that
that
we're
bound
by
the
ifc
schedule.
So
it's
it's
really.
D
Tom
verducci
for
the
record,
so
I
think
any
any
decision
where
we
go
on
this
should
allow
some
technical
adjustments
in
terms
of
some
of
these
variations
that
we've
made,
like
you
know,
for
example,
I
don't
understand
how
some
of
our
co-pays
had
changed
here
I
mean:
where
do
these
figures
come
from?
Was
this
from
aeon?
As
far
as
some
of
these
technical
amendments
on
the
plan,
design.
K
This
is
a
colleen
huber
with
and
for
the
record
correct,
so
within
the
grid
itself.
I'm
not
sure
if
the
question
is
on
the
grid
itself,
but
you
have
your
current
level.
K
Your
current
plan
designs
with
the
column
to
the
right
of
it,
the
pre
pandemic
plan
designs
and
then
the
propose
is
the
the
third
column
and
that
you
can
see
the
impact
of
the
how
much
of
that
would
cost
over
the
three-year
plan
design,
and
so
we
modeled
it
out
for
the
cdhp
plan,
the
copay
plan
and
the
epo
hmo
plan
in
the
far
right
hand
side.
So
all
of
the
cells
that
are
colored
green.
K
D
Okay,
thank
you
yes,
because
I
do
some
see
variations
here
in
deductibles
and
I
just
don't
ever
recall
having
a
discussion
on
the
plan
design
and
coming
up
with
these
figures.
So
I
was
just
trying
to
ascertain
where
the
figures
came
from,
so
I
do
see
it's
a
process
of
aeon
coming
up
with
the
final
numbers
here.
I
G
Yeah,
this
is
tim
zettinger
for
the
record,
so
we
have
the
last
two
years
for
py20
and
py21
for
the
cdhp
about
six
percent
of
employees
or
contracts
have
reached
their
out-of-pocket
maximum
for
the
epo.
We
have
1.2
percent
for
py
20
and
for
py
21
we
have
half
a
percent
and
then
for
the
hsa,
so
for
every
50
of
seed
that
we
give
to
the
employees.
G
I
F
So
this
is
betsy
aiello
for
the
record,
and
this
is
probably
a
very
elementary
question.
But,
as
we
heard
you'll
come
back
in
february
or
march
and
do
the
rate
setting
and
the
rate
setting
is
based
on
the
the
plans
we've
chosen
and
so
for
sure.
If
we
choose
option
two
or
option
three
everything
else
remaining
the
same,
the
premiums
for
option
three
will
be
higher
than
the
premiums
for
option
two.
F
So
one
of
the
things
we're
looking
at
here
is:
we've
heard
a
lot
of
testimony
that
people
want
the
higher
benefits,
but
I'm
not
sure
that
people
want
the
higher
premiums
if
they
realize
that
that's
what
it's
doing
but
february
is
going
to
be
february
and
so
option.
One
would
have
the
very
lowest
premiums
option
two
middle
and
option
three
higher
for
all
categories
would
be
my
guess,.
G
Yes,
jim
barnes,
for
the
record,
I
wonder
how
confident
is
aeon
in
these
projections
I
mean:
what's
the
range
of
likely
outcomes
are?
Are
you
confident
that
these
are
on
point,
because
I
know
for
a
dozen
years
running
that
it's
always
been
over
conservative?
And
I
I
wonder
if,
if
that's
done
on
purpose
or
or
do
you
do,
you
feel
confident
that
these
are
hard
figures.
K
So
this
is
calling
heber
for
the
record
from
ann,
so
these
are
the
best
information
we
have
at
this
point.
So
we
are
using
your
most
up-to-date
claims
experience
with
the
trend
levels
of
five
percent
for
medical,
eight
percent
for
pharmacy
and
three
percent
for
dental.
We
also
factored
in
to
account
any
contract
savings
that
were
a
result
of
your
procurement
at
that
time,
as
well
as
we
did
take
into
account
the
potential
savings
that
is
out
there
today
as
a
result
of
potential
procurements.
K
Once
you
award
that
business
now,
if
you
don't
award
that
business,
obviously
that
would
directly
impact
our
calculations,
the
other,
the
biggest
unknown
would
be
on
the
trend
side.
So
and
again,
with
the
covet
factors
and
anything
that
could
potentially
impact
your
trends.
K
We're
just
trying
to
use
the
best
information
that
we
can
as
as
we
get
so
we
realize
that
when
we
come
back
in
the
spring,
we
will
again
refresh
all
of
our
numbers,
taking
into
account
the
most
up-to-date
information
that
we
have,
whether
it's
the
inflation
levels,
whether
it's
current
trends,
which
whether
it's
national
trends
in
nevada's
trends.
Specifically,
we
try
to
factor
those
all
into
consideration
as
much
as
we
can
and
then
continually
refresh
our
projections
such
that
you
all
as
the
board
members
have
the
information
that
you
need
to
make
those
decisions.
B
A
A
So,
for
you
know,
aeon
using
five
and
eight
as
sort
of
at
postcode
normalized
is
still
higher
than
what
pebb
has
in
its
budget
for
trend,
and
that's
one
of
the
reasons
that
you
know
I
feel
a
little
bit
less
comfortable
with
option
three
as
much
I
mean
this
is
tough
for
me,
because
I
would
like
to
restore
benefits
and
you
know,
make
things
sort
of
what
they
used
to
be
for
participants
as
much
as
anybody
else.
A
But
to
remember
yellow's
point
that
you
know:
26
million
dollars
is
the
cash
we
have,
and
so
it's
got
is
so
the
differential
between
26
and
33
has
got
to
come
from
somewhere
and
it's
not
coming
from
subsidy
dollars
because
that's
set
in
law.
So
it's
coming
from
premiums,
and
that
would
be
that's
the
choice
so
and
we've
got
a
trend
in
the
ledge-approved
budget
that
is
less
than
what
our
actuaries
think
it
is.
It
really
is,
or
should
be
to
the
best
of
their
knowledge
all
right.
A
I'm
sorry,
ms
middleton,
you
got
a
question.
Yes,.
J
J
K
D
Oh
thank
you,
tom
verducci,
for
the
record
I'm
trying
to
figure
out
what
we
have
in
differential
cash:
excess
cash.
We
normally
have
a
budget
and
there's
utilization
reports
in
this
binder
and
I'm
kind
of
wondering
why
we
have
such
thin
material.
Here
I
mean
it's
usually
a
real
thick
packet
that
shows
up
and
we
have
a
thin
packet
today
without
utilization
and
budget
reports
and
just
wondering
where
did
where
did
it
go?.
A
A
I
removed
from
the
agenda
a
lot
of
the
usual
budget
report
and
utilization
report
stuff
that
you're
correct.
We
do
see.
I
general
I
wouldn't
normally
do
that,
but
I
made
that
decision
based
on
time
constraints,
because
I
don't
want
you
guys
to
to
starve
to
death
and
stay
here
all
day.
D
Normally
we
have
the
performance
guarantees
and
my
question
that
I
couldn't
find
here
is
how
much
excess
reserve
do
we
currently
have
on
hand?
I
think
I
was
reading
40
million
and
I
don't
know
if
that's
overstated
or
understated,
but
usually
that
comes
out
of
the
budget
report.
C
K
Hello,
this
is
carrie
eaton
for
the
record.
C
So
at
the
laura
ridge
for
the
record,
at
the
last
board
meeting,
we
were
looking
at
close
to
40
ish,
but
we've
made
obviously
there's
some
buy
down
subsidies
and
medicare
hra,
and
things
like
that
that
we
are
required
to
use
that
differential
cache
for,
and
so
that
has
you
know
that
would
bring
down
those
numbers.
But
what
I
do
want
to
say
is
the
projections
again.
C
Overall,
we
have
to
keep
in
mind
that
the
projected
savings
from
all
of
these
contracts
are
taking
into
account
here,
and
that
is
not
part
of
the
budget
report,
and
so
what
we're
looking
at
is
projected
savings,
and
I
can't
go
line
item
by
line
item
and
I
have
to
aggregate
it
all
because
of
the
confidential
nature
of
of
the
solicitation
process.
C
But
there
is
a
very
significant
amount
of
savings
in
in
these
contracts
that
have
contributed
to
the
higher
amount,
and
so,
mr
fruducci,
it's
not
it's
not
necessarily
just
the
what
you
would
see
on
the
budget
report.
It's
additional
items
that
staff
and
aeon
have
taken
into
consideration
because
of
the
projected
savings
that
the
plan
will
likely
experience
next
year.
As
these
contracts
are
put
into
place,.
K
And
this
is
colleen
heber,
for
just
for
the
record.
Aeon
is
working
very
closely
with
laura
and
her
staff,
just
such
that
with
every
type
of
negotiation
or
contract
change
or
procurement
award.
We
are
always
re-evaluating
and
incorporating
that
into
our
projections,
just
so
to
to
ensure
that
we
are
using
the
most
up-to-date
information
possible.
So
we
try
to
work
closely
with
laura
and
her
staff
on
that.
C
In
laura
ridge
for
the
record,
this
is
also
part
of
the
discussion
as
to
why
we
only
discuss
differential
cash
one
time
a
year.
It's
a
snapshot
in
time.
It
depends
there's
there's
it
goes
up
and
down
throughout
the
year
and-
and
so
it
is
very
difficult
to
take
a
point
in
time.
Just
like
kerry
said
a
month
ago,
it
was
probably
a
lot
different
than
it
is
today
right,
and
so
it's
just
a
snapshot
in
time.
C
That
is
why
we
have
made
a
decision
to
discuss
that
one
time
of
year
and
that
that
is
after
the
budget
is
closed
and
and
we've
closed
the
books
for
the
year.
So
that's
at
the
september
board
meeting
so
we're
really.
What
we're
using
here
is
the
september
board
meeting
information
and
what
we've
done
since
then
in
terms
of
projections-
and
you
know,
cost
savings
to
the
plan.
I
Remember
kelly
michelle
kelly
for
the
record,
so
I'm
just
looking
at
the
different
options,
which
kind
of
expanded
to
six
right
from
three
to
six
and
just
with
slight
tweaks,
so
executive
officer
rich,
which
is
the
staff's
recommendation
at
the
moment.
C
The
staff
recommendation
is
really
any
of
the
options
that
hover
around
that
26
million
dollars
right,
and
so
that
is
what
staff
feels
comfortable
with.
So
in
terms
of,
you
know,
option
two:
we're
looking
at
either
option
two
that
was
originally
in
the
report
or
the
slight
tweaks
in
option
two
that
you
see
in
the
addendum
right
and
so
really
either
one
of
those
works
it.
You
know
the
the
option
two
and
the
addendum
is
more
close
closely
really
or
closely
to
similar
to
the
the
plan.
C
That's
in
place
today,
where
the
epo
and
hmo
have
lower
or
no
co-pays
to
the
copay
plan
right
and
so
the
addendum
is
it
kind
of
tweaks
it
a
little
bit
to
to
more
closely
relate
to
what
we've
got
today,
but
really
I
mean
staff
is
comfortable
with
anything
that
the
board
would
choose
that
uses
that
26
million
dollar
option.
I
And
just
but
kellie
michelle
kelly
for
the
record,
so
just
a
follow-up
on
the
cdhp,
so
none
of
the
the
the
kind
of
option
for
that
is
the
same
across
both
different
designs.
I
guess
you
know
one
one
and
one
on
the
revised.
I
Can
you
talk
about
why
the
kind
of
the
choices
you
made
here?
I
know
the
board
had
directed
in
september
kind
of
bringing
those
deductible
and
the
oops
down,
but
and
and
in
this
option-
you've
done
that,
but
you've
left
the
hsa
stable
between
now
and
kind
of
600
and
600..
I
Did
you
explore
kind
of
looking
at
maybe
keeping
the
oop
a
bit
higher
and
offering
members
of
that
plan
a
little
more
in
hsa
money?
What
did
that
end
up
being
cost
prohibitive?
Was
there
you
know?
Is
there
rhyme
or
reason
to
this
choice?
I
guess.
C
G
G
So,
for
current
plan
designs,
we
have
a
five
thousand
dollar
out-of-pocket
maximum
and
for
option
one.
We
dropped
that
to
forty
four
hundred
dollars
for
employee.
Only
now
we
could
provide
each
employee
in
the
cdhp
eighty
dollars
of
hsa
seed
and
that
would
have
an
equal
cost
for
the
cdhp
over
three
years,
similar
to
option
two.
We
could
provide
a
hundred
and
sixty
dollars
in
hsa
seeding
and
replace
that
four
thousand
dollar
out
of
pocket
maximum
and
then
in
option
three.
G
D
A
A
Okay,
board
members:
is
there
a
second
on
that
motion
I'll?
Second,
all
right,
all
right,
so
the
option
before
the
board
is
to
use
33
million,
in
other
words,
so
revive
option.
Three
of
the
revised
plan
design
that
we
got
yesterday,
not
the
original
option,
three
that
we
got
in
the
original
meeting
packet
for
a
total
of
33
million
dollars
in
differential
cash.
Oh
I'm!
Sorry!
Yes!
Is
there
a
question
on
the
motivation
this.
A
I'll
take
a
sh,
oh,
I
would
love
to
kick
it
to
aion,
but
I
would
I
know
from
budget
experience,
but
I'll
stop
talking.
Oh
yeah
I'll
run
my
mouth,
I'm
fine!
Yes,
I
think,
is
the
short
answer,
because
right
we've
only
got
one
more
fiscal
year
of
this
current
biennium
and
we
have
cash
in
the
bank.
A
If
you
will
more
than
what
it
would
cost
for
one
year
of
enhancement
at
option
three,
but
then
we
don't
know
what
happens
in
budget
years,
24
and
25,
and
if
we
end
up
with
less
than
the
three
year
total
of
33
million
dollars
right.
That
would
be
an
increase
in
subsidies
during
budget
building
or
an
increase
in
premiums
during
plan
design
and
rate
setting.
So
you're
right
in
that
sense
aon.
Would
you
like
to
add
anything
to
that.
K
This
is
kelly,
and
I
agree
with
everything
that
that
laura,
which
just
said
also
keeping
to
account,
I
mean,
and
I'm
not
sure
these
would
be
the
plan
design
changes
for
the
next
upcoming
plan
year.
I
would
imagine-
and
you
also,
since
it's
a
three-year
look-
you
may
be
able
to
also
re
readjust
them
if
needed
as
well.
That
might
be
another
option
too.
A
J
You
know
we
talk
a
lot
about
sustainability
and
listening
to
executive,
member
or
rich.
You
know
she
provided
those
different
options
and
then
what
the
board
was
comfortable
with.
So
I
would
rather
go
with
a
more
conservative
option
rather
than
give
members
benefits
for
a
year
or
two
and
then
run
out
of
money
and
have
to
come
back
and
say
sorry,
no
more
money.
We
have
to
change
again.
So
I'm
I'm
concerned
about
premiums
and
I'm
concerned
about
sustainability,
and
I
won't
be
supporting
option
three.
I
I
Even
the
aggressive
projections
have
been
somewhat
conservative
and
we
have
ended
up
with
excess
reserves
that
have
been
swept
by
the
state,
and
so
I
think
that,
given
that
the
board
made
the
very
prudent
decision
in
september
to
kind
of
try
and
spread
these
giving
back
the
money
across
three
years
for
good
reason
to
say
that
we
didn't
have
to
increase
premiums-
and
we
also
you
know-
could
keep
plan
design
somewhat
stable.
I
I
acknowledge
that
I
think
it's
a
really
prudent
decision,
but
I
also
think
that
employees
right
now
are
extremely
challenged
and
that's
why
I'm
supportive
of
this
motion
that
we
have
the
option
if
claims
projection
gets
worse
over
the
next
12
months.
You
know
it's
going
to
start
to
tell
a
story
right.
People
are
getting
services
again.
I
A
Okay,
so
there
is
a
motion
on
the
floor.
It's
been
moved
and
seconded
to
approve
option
three
to
use
up
33
million
dollars
in
differential
cash
over
the
next
three
plan
years,
all
in
favor
signify
by
saying
I
I.
A
B
D
A
Okay
motion
carries
all
right.
A
Okay,
since
we
took
six
and
seven
out
of
order
now
we're
going
back
to
agenda
item
four,
the
consent
agenda
board
members,
you've
seen
the
minutes
and
the
pebbs
arp
rescue
plan
funds
request.
Do
you
have
any
questions
on
either
of
these
consent
items.
A
J
B
A
Record
I'll
second,
thank
you.
Okay,
all
those
in
favor
signify
by
saying
aye,
aye,
aye
aye,
any
opposed,
say,
nay.
Okay,
motion
carries
executive
officer
report,
agenda
item,
5.
C
C
As
the
board
knows.
In
october,
the
interim
finance
committee
approved
pebb's
5
million
work
program
for
the
use
of
crf
funds,
so
we
will
be
receiving
5
million
dollars
for
reimbursement
of
covid
related
claims,
but
in
november,
pebb
was
informed
by
the
governor's
finance
office
that
an
additional
five
million
dollars
would
be
made
available
to
penn
for
additional
crf
money
that
is
set
to
expire
on
12,
31
or
21..
C
The
problem
is
that
these
claims
have
to
be
reimbursed
and
they
so
they
they
have
to
occur
and
be
reimbursed
by
by
december
31st,
and
so
we
did
not
project
that
we
were
going
to
have
an
additional
five
million
dollars
in
covid
related
claims
by
that
point,
and
so
we've
reduced
that
amount
to
3.6
million
dollars
in
sierra
funding.
C
As
you
heard
director
young
speak
to
earlier,
the
enrollment
knowledgeability
system
update.
We
just
wanted
to
talk
about
some
implementation
issues.
So
around
this
time
last
year,
lsi
was
awarded
the
contract
for
pebs
enrollment
and
eligibility
system.
Rfp
lsi's
also
contracted
through
the
office
office
of
project
management
to
oversee
the
smart,
21
statewide
erp
implementation.
C
C
So,
in
addition,
the
challenges
experienced
on
the
smart
21
implementation
have
taxed
critical
resources,
which
are
also
vital
to
pebb
dhrm,
and
the
dhrm
is
the
division
of
human
resource
management
and
the
office
project
manage
project
management
throughout
the
implementation.
There's
been
many
assumptions
that
have
been
made.
Some
lack
of
communication,
some
light
changes
and
components
that
were
not
thoroughly
discussed,
and
that
is
that
that
has
contributed
to
concerns
about
a
successful
go
live
at
the
end
of
the
year.
C
In
several
cases,
the
issues
causing
concern
were
not
brought
to
our
attention
until
very
recently,
and
when
I
say
our
attention,
it
would
be
pep.
Most
importantly,
there's
concerns
for
payroll,
where
they
will
potentially
affect
pub's
ability
to
collect
premiums
and
and
in
the
and
how
this
is
going
to
affect.
C
You
know
on
the
payroll
side
as
well,
so
these
issues
have
been
escalated
to
lsi
leadership
and
pebb
has
been
assured
that
the
critical
payroll
issues
will
be
resolved
and
that
there
will
be
a
successful
go
live
of
the
new
system
on
january.
On
january
1st,
the
updates
I've
received
so
far
is
that
they're
making
progress,
but
I
think
it
is
prudent
for
the
board
to
understand
that
there's,
you
know
we're
down
to
the
wire
and
we
are
experiencing
some
very
major
concerns
with
this
implementation.
C
We
do
have
a
voluntary
benefits
update
due
to
the
mid-year
eligibility
system,
change
from
the
life
works
and
core
stream
product
that
we
have
today
to
benefit
focus.
A
two-week
voluntary
benefit.
Special
enrollment
period
occurred
between
november
8th
and
november
19th,
and
this
period
allowed
members
to
enroll
or
cancel
their
voluntary
products.
C
So
some
new
voluntary
products
were
were
offered,
some
of
them
remained
the
same,
and
this
allowed
members
to
go
in
and
make
changes
during
that
time,
the
below
enrollment
chart
on
page
three
reflects
approximately
72
percent
of
the
total
2960
additional
enrollments
that
occurred
during
this
period.
They
were
for
brand
new
plan
offerings,
mostly
with
the
standard
who
replaced
aflac
for
accident,
critical
illness
and
hospital
indemnity
plans,
as
well
as
the
new
long-term
disability
plan
that
we
offered
in
order
to
replace
the
benefit
cut.
C
C
Option
this
period
also
allowed
members
to
create
new
accounts
and
become
familiar
with
the
system
before
it
goes
fully
live
at
the
end
of
the
year,
with
2370
new
accounts
that
were
created
and
over
4
300
logins.
So
you
can
see
on
that
chart.
We
do
have
quite
a
bit
of
enrollment.
It
shows
what
people
were
enrolled
in
versus.
You
know
what
changes
happened
through
this
enrollment
period.
C
We
do
have
in
the
audience
today
and
as
well
joining
virtually
both
members
representatives
from
benefitfocus
and
from
lsi
here
as
well.
If
the
board
has
any
questions
for
them,.
J
According
to
executive
officer
rich's
report,
it
looks
like
there
were
some
problems
and
delays
with
implementation
that
were
not
communicated
in
a
timely
manner.
So
my
question
to
the
vendor
is:
why
were
those
issues
not
communicated
more
timely
and
rather
communicated
just
before
implementation,
so
that
question
is
for
the
vendor.
Thank
you.
C
B
This
is
not
gonna,
am
I
gonna
you
guys
from
benefitfocus.
B
C
Think
that
I
think
the
oh
sorry,
I
think
the
question
was
surrounding
the
delays
and
why
the
delays
on
the
smart
21
project
were
not
communicated
in
a
timely
manner
to
the
pebb
project
and
specifically
since
lsi
oversees
both
of
these
projects.
So
they
oversee
the
smart
21
and
they
also
hold
the
contract
for
the
pad
implementation
as
well.
E
A
This
is
laura
food.
Well,
if
there's
no
one
who
can
answer
the
question,
then
I
guess
we'll
have
to
table
it,
and
you
know
the
board
can
always
ask
ms
rich
and
her
staff
to
send
a
letter
to
lsi
with
the
board's
questions.
For
me,
the
question-
and
I
guess
this
is
more
for
peb
staff.
A
C
Laura
rich
for
the
record.
First
I'd
like
to
ask
nick
one
of
my
stuff
nick
propper:
if
would
you
mind
going
out
there
and
grabbing
scott
he's,
probably
on
the
phone
out
there
yeah
thank
you
and
to
answer
your
question
jeffrey.
So
when
there
is
an
implementation,
especially
as
complex
and
in
you
know,
invest
as
as
the
enrollment
and
eligibility
system
for
pebb
is
we
always
expect
that
there's
going
to
be
some
hiccups
right,
I
mean
no.
No,
I
t
implementation
goes
100
smoothly,
you're
going
to
expect
some
issues.
C
My
expectation
for
a
smooth
go
live
is
that
members
are
able
to
access
their
accounts
they're
able
to
enroll
in
in
in
health
benefits
right
so
in
an
insurance,
and
if
there
are
new
employees
and
that
they
were
able
to
make
changes
to
their
current
enrollment
as
far
as
adding
dependents
or
taking
dependents
off
et
cetera,
et
cetera,
right
and
then
also
that
the
payroll
components
are
performed
smoothly
and
we
have
payroll
deductions
that
occur
in
a
timely
manner
and
do
not
affect.
C
Employees
in
a
negative
way
to
where
you
know
now,
their
paychecks
are
affected
because
they
do
not
have
premiums
taken
out
or
you
know,
we've
got
to
take
two
out
at
a
time
or
you
know
something
like
that.
So
it
really
what
I'm
looking
for
is
overall
mitigation
of
any
employee
impacts
to
their
paychecks
and
their
ability
to
enroll
in
health
insurance.
C
G
G
A
J
Okay,
sorry,
I
tried
to
destroy
my
microphone
leslie
biddleston
for
the
record,
and
this
is
from
executive
officer
rich's
report
directed
to
the
vendor,
who
is
lsi
so
in
miss
rich's
report.
There
was
some
discussion
about
some
problems
due
to
implementation
and
the
late
or
untimely
communication
of
those
problems.
J
B
Hello
born
board
members,
scott
muir,
for
the
record.
I
am
the
executive
program
manager
for
lsi
on
both
the
smart
21
and
the
pebb
project.
B
So
to
your
question
on
communications,
I
just
want
to
make
sure
I
I
captured
it
right
on
why
there
wasn't
more
pre-advanced
notice
around
the
delay
or
the
need
to
make
this
switch.
If
you
will
to
the
advantage
system.
J
So,
as
a
long
time
state
employee-
I
mean,
I
understand
the
rfp
process
and
I
understand
that
you
were
selected
as
a
vendor.
So
the
question
is,
as
you
began,
your
process
as
a
vendor,
and
you
began
to
maybe
identify
some
problems
that
you
know
it
sounds
like.
Those
problems
were
not
communicated
timely
to
ped.
So
my
question
to
you
is:
why
was
there
a
lack
of
communication
and
what
could
you
have
done
to
do
better?
You
know,
because
you
have
a
january
first
implementation
right.
So
will
we
be
able
to
make
that
on
time.
B
B
And
and
I'd
defer
to
nick
as
well,
I
believe
when
we
started
to
understand
that
there
was
going
to
be
a
delay.
Let
me
let
me
back
up
one
step,
so
the
original
plan
was
to
couple
the
peb
project
with
the
smart
21
project,
as
it
relates
to
being
able
to
use
the
smart
21
payroll
platform
and
not
have
to
rely
on
the
advantage
platform
and
those
project
dates
at
the
time
both
contracts
were
awarded
and
planned
for
all
seemed
to
coincide.
B
B
We
didn't
know
the
exact
delays
at
that
point
and
I
think
it
was
like
mid-summer
to
end
the
summer,
but
I'll
get
you
the
exact
dates,
but
when
we
started
to
get
closer
to
understanding
that
smart
21
was
not
going
to
go,
live
from
a
payroll
perspective
on
january
1st,
as
planned,
we
all
work
together,
benefitfocus
ourselves,
opm
to
then
figure
out
how
we
could
continue
to
make
the
january
1st
go,
live,
successful
and,
as
I
think
nick
pointed
out,
where
we
are
right
now
is
we've
all
come
together
as
the
parties-
and
I
just
checked
this
morning
before
I
came
over,
the
testing
is
going
well
and
as
we
sit
today,
not
to
say
that
there
won't
be
things
that
will
pop
up,
but
the
collective
team-
and
I
asked
nick
to
to
kind
of
chime
in
here
as
well.
J
So
as
a
follow-up,
thank
you
as
a
follow-up.
Having
worked
with
vendors
for
a
lot
of
years,
unfortunately,
I've
experienced
vendors
that
sometimes
bite
off
more
than
they
can
chew.
So
they
say
they
can
do
this,
but
they
can't
or
they
can.
But
it's
going
to
take
more
time.
So
as
a
vendor
of
pebb,
we
would
expect
you
know.
I
would
expect
of
any
vendor
of
the
state
of
nevada
to
be
very
communicative
and.
B
B
C
J
This
is
this
affects
a
lot
of
members,
and
we
want
to
make
sure
that
you
know,
like,
like
executive
officer,
rich
said
that
we
don't
want
to
take
two
or
three
premiums
at
once,
because
the
payroll
system
isn't
working,
correct
or
or
something
like
that
yeah.
You
know
because
everybody's
hurting,
our
members,
we've
heard
it.
So
it's
just
we
would
expect
our
vendors
to
to
you
know,
be
more
proactive
rather
than
less
proactive.
B
J
Untimely
communication
doesn't
make
me
happy
so
anyway,
but
so
so
thank
you
for
your
answer
and
and
we'll
look
forward
to
a
successful
implementation.
On
january
1st.
B
Great
and
if
I
can
just
follow
up,
I
just
want
to
acknowledge
that
and
that
we
have
put
remediation
steps
in
place
both
on
the
smart
21
side
and
the
pebb
side
to
have
that
effective,
regular
communications,
and
I
would
hope
that
laura
and
the
team
would
all
acknowledge
that
we've
we've
tried
to
mitigate
that.
So
thank
you.
G
Thank
you,
miss
rich
nick
proper
for
the
record
to
be
able
to
be
qualified
for
a
long
term,
disability
plan
or
other
life
insurance,
voluntary
benefits.
They
must
be
approved
through
an
evidence
of
insurability
and
medical
forms.
We
cannot
bypass
that
requirement
and
that
is
a
requirement
of
the
carrier.
A
This
is
laura
freed.
I
have
one
final
question
for
pep
staff:
does
the
contract
with
lsi
and
benefitfocus
contain
penalties
that
will
be
assessed
if
on
go
live
the
wrong
premium
is
deducted
from
a
member's
paycheck
or
the
data
transfer
doesn't
work
or
one
of
those
other
things
that
we
are
afraid
of
happening,
I.e
the
opposite
of
what
ms
rich
described
as
a
successful
rollout
happens
and
what
are
those
penalties.
C
A
A
I
want
to
I
want
to
caution
that
if
there
are
detailed
questions
before
I
throw
it
to
ms
eaton
there,
if
there
are
detailed
questions,
we
may
have
to
go
into
closed
session,
and
so,
depending
on
the
questions,
I
may
call
timeout
and
tell
broadcast
that
we
need
to
go
in
a
closed
session.
C
So
laura
rich
for
the
record,
miss
eaton
usually
gives
this
report
and
she
is
on,
but
she
is
on
vacation
technically,
so
I
don't
want
to
make
her
do
any
more
work
than
she
needs
to
do
so
I
told
her.
I
would
do
the
report
for
her
so
8.1.
You
guys
have
seen
this.
This
is
just
the
contracts
overview.
This
is
the
table.
That's
included
in
this
report.
Typically
so
I'll
just
move
to
8.2,
which
is
new
contracts.
C
So
the
rfps
were
released
for
the
tpa,
hsn,
hra
administrator.
Second,
opinion
services,
telemedicine
service,
intel,
medicine
services
and
peb
staff
have
negotiated
successfully
negotiated
contracts
for
all
of
these,
so
the
first
one
8.2.1
is
the
tpa
they
on
april
26
2021
that
the
public
employees
benefits
program
released
the
proposal
for
the
tpa.
What
we
were
looking
at
here
is
to
acquire
a
health
and
dental
benefits
administrator.
C
C
Although
hellscope
benefits
is
the
incumbent,
they
are,
they
were
bought
out
by
umr,
and
so
basically
it's
it's
umr
is
not
the
incumbent,
but
is
the
closest
to
it
really,
and
so
it's
not.
The
transition
would
not
be
really
they've
got
all
our
data
they
have.
We
would
have
the
same.
The
same
account
reps,
and
so
it's
even
though
umr
submitted
the
proposal.
It's
still
using
the
hellscope
benefits
staff
with
some
changes,
technology
changes
and
things
like
that.
C
So
umr
will
be
the
new
vendor
for
peb
for
tpa
services.
However,
since
umr
is
the
parent
company
to
the,
as
I
said,
to
hellscope
benefits,
the
transition
is
expected
to
be
overall,
less
disruptive
for
members
and
will
require
minimal
implementation
to
you
know
to
move
on
to
that
product
and
as
part
of
the
proposal,
umr
submitted
two
network
options,
one
using
the
incumbent
network,
which
is
aetna
and
another
leveraging
choice
and
show.
C
The
aeon
analysis
shows
that
minimal,
minimal
in-state
disruption
and
significant
cost
savings
with
the
latter.
So,
additionally,
by
leveraging
the
proprietary
networks,
members
were
able
to
take
advantage
of
self-service
technology
in
the
umr
portal
that
is
currently
not
available
through
pep
today,
such
as
shopping
comparison
tools,
interactive
provider,
searches
and
insight
into
prior
authorization
requests.
C
So
in
order
to
use
the
choice
and
show
networks
and
have
access
to
the
above,
umr
also
requires
utilization
management
case
management
services
to
be
incorporated
into
this
contract
and
currently
have
contracts
with
american
health
holdings
for
these
services,
so
that
contract
is
due
to
expire
on
june
30th
of
2023.
C
So
pebb
must
issue
a
no-cost
termination
in
order
to
end
that
contract
a
yearly
additionally,
pebb
will
also
need
to
issue
a
no-cost
termination
to
aetna
which
who
currently
holds
that
contract
for
the
in-state
network
as
well,
and
although
this
contract
was
recently
awarded
because
and
just
to
give
you
a
little
bit
of
background
so
typically
when
the
industry
standard
is
to
rfp
for
a
tpa
that
comes
with
a
network
right,
and
so
it's
it's
a
kind
of
a
bundle
deal.
C
Typically,
organizations
don't
go
out
to
bid
for
a
tpa
and
then
a
network,
because
those
two
are
so
closely
closely
associated
that
usually
it's
it
comes
as
a
package
deal.
Pebb
was
set
up
in
a
way
where
we
we
had
to.
We
were
put
in
a
place
last
year
or
two
years
ago.
Actually
now
that
we,
our
contract,
was
expiring,
and
so
we
had
to
go
out
to
bid
in
order
to
secure
a
new
network.
C
But
we
wanted
to
fix
this
by
at
least
allowing
net
a
tpa
to
propose
a
network
and
and
taking
it
as
a
bundle
deal
if
it
were
a
situation
where
it
were
a
benefit
to
pet,
and
so
it
that
is
the
situation
here,
and
that
is
why
umr
bid
using
both
networks
network
options.
C
C
C
With
this.
With
this
proposal,
it
is
an
integrated
service
of
the
tpa
contract,
with
the
use
of
that
selected
network,
so
umr
also
bid
and
was
selected
as
the
winning
vendor
for
the
additional
ancillary
services,
as
second
opinion
services
and
telemedicine
services.
So
second,
second
opinion
is
umr.
They
are
partnering
with
second
md.
They
are
also
partnering
with
doctor
on
demand.
Those
are
the
two
current
services
that
we
use
today,
so
there
would
be
no
changes
to
that
and
the
contract
max.
It
does
include
the
fees
associated
with
those
services.
C
A
Okay,
thank
you
my
thanks
to
any,
but
the
board
members
who
are
on
the
tpa
evaluation
committee,
because
the
tpa
rfp
is
no
joke.
So
thank
you.
Whoever
you
are
questions
board
members.
A
A
Well
with
that
lcb
broadcast
services.
If
we
could
go
into
closed
session
and
take
the
time
you
need
to
arrange
that.