Homeless Issues Committee - Regular Meeting

But we're gonna call the meeting to order at 08:30 here. Nate has started recording. We are confirming. So I'm just gonna pull up. Thank you, everybody. I know this was, another meeting that ended up rescheduled due to technical problems, so thank you. Oh, and Scott's here, so we have a a flip house. But thank you everybody for for making time to to redo this.

And, Marissa, you do have a quorum because everybody's here. So just so that's on the record.

Perfect. Thank you, Amy.

Yep.

Alright. So we've been called to order, and our first order of business Hello. Jerry's here.

Okay.

Our first order of business is to review the minutes from both the February and March meetings. Do I have a move to approve the let's start with February. A move to approve the February meeting minutes.

Tisha will make that motion.

May 2?

I don't think there is. Any comments on the minutes or corrections? Or I think there is one typo. I I think it's a typo in the second part of the presentations that says that Nate did an overview on what data vendors I think you said ask for. You said should they be ask?

What date did they ask for? Most likely.

Yep. Ask for to

Ask for. Ask for. Yep. So perhaps we just correct that. So Okay. Any other?

Excuse me.

Someone can help me if I don't know. In a small committee like this, do I need a second to to be I don't know this.

Use well, so the motion can be to accept the minutes with that Okay. Amendment. So I will make that motion. I'll second it.

Alright. Second by Shannon. All in favor of approving these minutes?

Aye. Aye.

Any opposed? Alright. Thank you. So we're done with the February minutes. Moving on to March minutes. Do we have a motion, regarding the March minutes? So moved. Shannon moves to approve the March minutes. Second by Tisher. Any discussion or edits to those minutes?

Hearing none, all in favor of approving the March minutes?

Aye.

Aye. Aye. Any opposed? Alright. Good with March. Thank you. Alright. So I think we can then move on to our order of business today, which was to kind of zero in on the current mandatory requirements list. Mhmm. Anyone who is more from you know, I pulled this out.

I copied these requirements out of the RFP. So if I missed anything, I hope somebody will alert me, please. But, otherwise, I guess the hope is that we can just kinda go through these one by one and see if all of these need to stay on a mandatory requirement list. Is there anything that we could possibly shift to a preferred requirement list, or any other ideas folks have?

Do the list pulled up and share it.

I can email it to you. You're already on

Yep. This. You got it. Yeah.

I'll just forward it. I'm gonna forward this to Nate. So he's gonna be able to share it for us.

Oh, I'm probably not online. You on the email, it was 414 from Linda.

If you can't find it, I can get on the Internet.

Guess, you know, everybody else. That's good.

Okay.

I'm sorry. I didn't even get your next one right now. It's okay.

Alright. Here we go. Zoom in a little bit. Yeah. Perfect.

Alright. So the mandatory requirements, this first general section, there are eight. So I guess we can start with one. Vendor must be able to provide ID cards without identifying Social Security numbers on the cards. Mhmm. I think

that needs to stay as a mandatory requirement.

That's pretty much standard too. But way back in the day, carriers would have the ID or your social on there, but, yeah, that's Similar to Medicare. Yeah. Exactly. Yeah.

Yeah. K.

So this is, what I'm hearing is this is standard. This is not something that's causing

us any problems. Correct. Alright.

Number any other discussion on number one? Alright. Number two, vendor must be able to use the county's enrollment form attachment n.

Yep. I'm guessing that's probably not a

big deal for vendors, but I think

you and Amy would probably be the best ones to weigh in on that.

Yeah. That's a county. Yeah. It's a

county form because when you go into our county system, and then, Carol, you know, you log in, you enter help apply for the health insurance, and then she backs or scans in, probably now scans in and Yeah. Sends it to the carrier to enter.

It's probably not something that's

a hang up for vendors. Would Well,

I think wouldn't imagine it's Not No.

Think they don't care for it.

Yeah. Because I think a little bit of friction there. It's not preferred,

but it's not gonna break anything.

So they would prefer people Yeah.

It's their fault.

Use the portal.

Okay.

They would prefer people use the

You know, kinda like FlexPipe to sign up online. They they would prefer that. But right now and, Amy, I don't know if you know why that what the history of that is as to why we still are doing paper like that.

I have no idea. I think just because it's probably always been done that way.

I think that's gonna be a lot of

you know

Sorry. Go ahead, Chuck.

You know, it goes way, way back. And even now with the county, we use our own portal to fill out, you know, like, people to do their enrollment. So I feel like we could be flexible on this and get a report from the vendor relative to what we need perhaps.

K. I mean, I think it would stop some of the keying errors and those types of things. I mean, because that really causes havoc with health insurance. Name and everything has to be exact. And if it's not, it won't be accepted at the clinic.

Birth. Yeah.

So an enrollment would be done by the member through the through the vendor's portal, and we wouldn't do anything.

But we'd they'd still have to notify the county so that we could put in, well, you know, the insurance in our system Okay. So that it's paid for or and or the employee pay their share. So, I mean, well, it's either we get the paper, we enter it, and then send the paper to the to the provider, or we key it into the provider's portal, and they provide us with documentation so we can key it in. I guess it's probably six of one half dozen of the other. But

Well, given staffing and how much time you know, Amy, maybe you can speak to how much time this takes our staff, and would it be at all helpful to shift any of this onto the health plan?

Well, Carol reports directly to Shannon, and I honestly have no clue how many hours Carol spends keying health insurance for people. So I'd have to ask Carol.

Yeah. And I don't know that it's gonna save her tons of time because she doesn't key anything in. She I mean, she don't get me wrong. She keys keys in the same thing she would have to key in whether it came through the portal or or through paper. She has to key it into our system The payroll system. Into the payroll system. Right. And then right now, she forwards a paper copy to the provider, and they do their thing. They key it in their system. So who would save time is the provider, not us necessarily.

Would it reduce any errors? Well, I

mean, it could unless the member made the errors. I mean, you know, there's and then sign one of the things that Carol does do before she approves it is make sure that they're signing up for the appropriate things. I mean, right now, when we have open enrollment, people will sign up for what they already have. And so then she could reject that so it doesn't go to the provider. So there are some reasons, I guess, I can see why she does it the way she does, you know, because our employees like to do things double instead of just understand that if you already have this insurance, you need to do nothing. They don't understand that phrase. So

They wanna they wanna make sure.

They wanna make sure. But then, unfortunately, you know,

we It just creates extra work for Carol, though, to double check to see they already have the same thing they just enrolled in.

Right. And I don't know

And then she declines it, and then they freak out and go, well, why'd you decline my application? Well, because it's what you already have. But I think the other thing too is Carol verifies birth dates, for new babies and, marriage certificates and all that. So I I don't know where that would fall. Would that go to the vendor then when they enroll or still Carol would need to do that, I'm assuming?

It be best to check with Carol before we make a decision on this on that one?

Sure. I mean, I think Carol will say that this is the best option. But, I mean, I'm happy to talk to her and see what her thoughts are on on, the portal. Because I know Dean has brought it up a few times that they would prefer that we work on their portal.

Yeah. And some of the dental carriers over the years too have have squawked about it. But, again, it's not a It's not a deal breaker. A deal breaker for the carrier. Correct.

Yeah. I I think there's some rule here.

Our objective if our objective is to try to remove as many barriers,

sensors

as possible to try to enhance it, Probably warrant some research.

Yep. Could could it also be written that the preference is the the paper enrollment, but we

would consider? Well, that's what we're trying to do is so come up with the mandatory list and a preferred list. And so what I'm hearing is that it's preferred that we do it by paper, but it might not be a deal breaker for us if a vendor said, oh, this is what we

Yeah. I mean, I I would feel better if I just got to talk to Carol a little bit before I say that. I'm just Okay.

But this one, what I'm hearing is this one's worthy of a little more looking at, it could be potentially shifted to a preferred list.

Yeah. It would be even better if we could just have our enrollment for upload to their system. But Yeah. That would be fantastic.

Okay. Maybe you could suggest that for the preferred list, Shannon. Alright. I mean, I I remember when I started, I think we did have an actual paper form. Yep. And so I don't have attachment n here. Does anyone know if it's attachment n, what's in the

Basically, it's a copy of the form, if I remember right. A copy the form? When I was Heather at Dean Okay. That handled the county, basically, the county mirrored Dean's one page application. I this is going back to 2000. So

what it what she uploads is what she print after people enter all their information into the into our portal, she prints off. There's a it converts to a paper copy, and then she prints that off. And

then,

well, prints it off and either scans it to them or Yeah.

Fast. Yeah. Prints it off?

What? If she has to. Yep.

And The cost savings there.

You could see it. Yeah. There.

I was doing some color coding with this. Hopefully, it

makes sense. Yep.

See if

it actually works. That's perfect. Thank you. Alright. So what I Shannon, you're gonna try to do a little more research on this one for us? Yep. Okay. Thank you. Let's go on to number three. Any other I'm sorry. Any other discussion on number two? K. Number three, vendor must assign a central point of contact for the county and its subscribers.

I think that's a definite one to keep in. You know, think back to p plus and Ron, and then, you know, it's been very good since. Mary at WEA and then Heather.

The only thing I would quote below is and its subscribers because

none of those For the county.

I don't think we need that part.

For the county? Yeah. Scrap and subscriptions.

Well, would that be part of the whole, designated, like, contact? Like, right now with health insurance, we have a dean number. I mean, I You

mean the we have the dean, the advanced question line.

Right. So, I mean, is that is that bad, or is that not bad?

I think this refers more to to Heather.

Mhmm. Yeah. Yeah.

Okay. Yeah. We don't want Heather

to be contacted by her.

Right. Okay. K.

Any concerns about striking ended subscribers?

Oh, none here.

But, otherwise, we're that one seems important. Mhmm. K. Moving on to number four. Vendor must provide regular explanation of benefit forms to subscribers as required under the ACA and when there are member costs associated with the services. Yep. That must

be Yeah.

That's probably non negotiable. Yeah.

It's not negotiable. I don't know if it it helps us to have it here, but

it makes the list Well, it has to in

because they're gonna do it.

Yeah. I mean, if it's already part of the ACA, I guess I don't know that we would need

to keep that language. What

if it's removed from the ACA, though? There's, you know, unpredictable things happening in the world.

This is true. I'm pretty pretty pause. There's certain times where the feds make changes and carriers

I would suggest we keep it in there.

Okay.

Or if they have to do it anyway, then that's not a barrier to anyone. Right. And we would want it if something did happen to the ACA, which we unfortunately can't predict. Yep. I did forget to ask Heather about this yesterday because I don't know if other people have noticed suddenly getting a ton of paper. Like, it the system changeover seemed to reset everybody's settings for EOBs. So people that used to get them electronically now are getting them by

Yeah. Yeah.

We have, of course, courses that too, and they send at least six pages It's for one outside

Been a lot. And I feel like they didn't use to send them when you only owed a co pay.

That's correct. They did not.

Now they are. And because

usually most people are paying their co pay right at the right at the the time of the visit. Yep.

Alright. Number five. Vendor must establish a dedicated portion of its website to communicate with county subscribers or provide the count county with its own page. The page would include a section dedicated to gender affirming care.

And this this has been an issue for some providers, has it not, with the the dedicated Who the big ones? Yeah. We'll do this.

Yeah. Make it happen, but UHC and Anthem, no. We're not gonna

Yeah. I think I saw it on the RFP for maybe it was it was the Blue Cross or Anthem.

Yeah. Yeah. One of them would not do it.

Yeah. And then the latter part, the this page would include a section, gender affirming care that obviously came as of the last few years. Right.

So do we make that a preferred?

I think it's a preferred. And I know the gender affirming care now is treated like every other medical condition, so I don't know that that would even be a requirement that it be a special section.

Right. I think right. I was trying to look at deans, and I think what they have is a link. They don't have so other discussion or thoughts on shifting this to preferred list?

What is the history of this? Is this just like, this is before, like, the Dane County website was hosting some of these things? Or

I think dub did WEA do something like that? P plus, I don't think did.

Because she

had oh, sorry. Go ahead.

We did not have our own special web page for the county. I mean, I have an insurance website that has all the stuff about health, dental, and everything else. But I think we asked for this just so it made it easier for our employees to find our stuff versus going to Dean's main website and trying to figure out which of the nine plans you select when the drop down menu comes.

True.

Like, am I a group health? Am I a this? Am I because there is a list that drops down, and you gotta figure out

Yes.

Which one you select in the first place.

So that would've come up when we came back in 2017.

Probably.

Yeah.

But it may be also at this point that by logging into their own portal, that's where you're finding your member documents and your own EOBs, and that's I mean, that's where I usually go look.

The experience

of doing it through kind of MyChart or through the portal might be better than general one. There are some when we talk with carriers about their, you know, kind of what do we want? What what can groups do to help be better consumers? Their number one answer is use MyChart and could go through that way because you're plugging the system, the reminders, and are more likely to do preventative stuff. I guess I would be, like, yellow at a minimum, but almost they could remove it. But we think there's still value in that. The other thing is they have to update it, and it doesn't it's not always current if there are changes. Right?

And that could be something we talk, you know, in finalist meeting. Well, hey. You know, if this does become the case, say it's not mean. Would you be willing to put this you know, have a section in your website?

Marissa Yep.

Yep. Scott?

I'm sorry. Could we include language that says you either have a dedicated employee portal solution or, you have the the county specific page. That way, it leaves it to the vendor to kinda decide what's better for them, And they can either drive everybody to using their own employee portal solution, or they could just do this county page if they feel like that's better for them.

Are there any health insurance companies that aren't don't currently have portals for people? Mm-mm. Like, you know, we go Scott, I think you're talking about the Dean Connect, right where you log in and you can see your EOBs and everything. Is that what you're referring to?

That's right. And I but I Amy's point is also very valid. You know, an employee just going to hunt this down on their own without some steering to the right place is just a recipe for disaster. So and I'm just trying to, you know, to suggest a way to make it as easy for the vendor to do as possible. So either or is kinda what I was thinking.

Either you have a dedicated page if that's what you think is easier to pull together and publish, or you have to commit to driving everybody to using an individual portal so that the employee is not left, you know, spending hours trying to figure out, well, what in the world from all these options am I supposed to choose?

Yeah. I mean, it is hard to know in the drop downs what what where we fit. That's very, very difficult. And And a lot of

times, it's confused with the state plan.

Yeah. Yeah. I often get people that are are calling Dean for assistance, and then they're given bad information because it's not the Dean County specific. Right. They're getting the generalized. Mhmm. And then they get a hold of me, and I'm I'm able to get a hold of Heather, and we fix things. But I guess if we could steer people in the right direction to begin with, it's just gonna cut down on, one, it will I think there will be more patient or member satisfaction because they'll get their problem dealt with immediately or a lot quicker. So, yeah, I I guess I would say that we should at least keep this in preferred, but I don't I don't think we should get rid of it entirely.

Because they may be able to come up with a way to do what we need, but not have it be a dedicated portion of their website. Mhmm. It shouldn't specifically just be a link. So preferred,

that would make

sense. Yeah. And

what about Scott's oh, did somebody have something online? Amy.

No. I was just gonna say that I kind of agree with Brian. It should stay in there somewhere, but preferred might be the way to go.

Yeah.

And then along Scott's line there, I think we might need to just kinda reword it a little bit.

Just like it's always yellow then.

Yeah. I mean, it could also be to include what Scott is hoping for, it could be an and or because I think it's obviously best if we have both.

Mhmm.

Sure. You know, which is what we have with Dean right now. Right. But, otherwise, it's a could be an and or.

And it's really to the the providers benefit as well. If it's easier for our people to find what they need, then they're not calling customer service

or calling back to customer service multiple times. So

Mhmm.

Or having an appeal. Mhmm.

Yeah. And I think, you know, we haven't heard the vendor, and, you know, that might be really important to them. It may be a nothing to them. So I think yellow makes sense just to open the discussion.

Right. Thank you. And I think we did know it was something because we did have a couple vendors not do it in the past. So it it does seem like one that's an opportunity for us. Anything else on number five?

Do we want that continued call out for dedicated gender affirming care? We continue that, or should we

I think there's something lower on gender affirming care. Maybe not. Thoughts on that?

Well, if it's required and it's already in the the information, do we need it to be specifically a a page?

I don't know. Can people on Zoom hear you?

Can you hear me?

Yeah. I can hear Shannon fine.

Okay. Yeah. Can hear.

See, no one's ever accused me of being quiet. I I get

you I get you on that.

It is a weird stuff. We're just not licensed to see you. Mean,

I I think back when we did this RFP, the gender affirming care was a big deal because a lot of insurance companies were not covering the services. But from my recollection from Heather, that has all changed. And the the affirming care is now just a standard medical care option that the doctors do. So I don't really know that we need to call it out as a separate thing.

Right. Well, because coverage of it and then information on it on the website are two different things as well. Yep. To from the m three perspective, is that seem like something that's a barrier needed or kind of it's a topic of many that could be

I can see a carrier just getting twisted around what that needs to to look like. I I don't think it's gonna be a deal breaker to have have that there. It's especially making the overall thing a a preferred requirement. Right.

You know, as we move forward, the carriers are probably gonna have more tech, easier tech to could probably expand on what it is today even with Dean. Right? What that what that option is today they have could be something that the next go around.

Right. No. It's something different. Affirming care coverage is a separate part of Right. Right. That's yes. Contract Yeah. Anyway. Correct. K. Does anybody have any concerns about that? He's being struck.

Does anybody have any concerns? So this is isn't really grappling with the fact that they provide the gender affirming care. It's just that they have a section on their website dedicated to it.

Dedicated. Correct.

Does anybody think that that has any sort of dampening effect on that care occurring if we if we were to take this requirement out?

I don't think so. Mean, I'm on Dean's website right now for Dean County, so this would be the dedicated information. And I don't know. Maybe you wanna share this.

It's a link.

Nate? Because it's, like, buried at the bottom. You know? So they're meeting the requirement, but is it, it just goes to their website on gender affirming care. But maybe if you guys could see it, you could see what I'll let Nate

I was trying I was trying to pull

it up here. Here's the

He's trying to send me here.

I mean, I'm not trying to dismiss this as a topic because I think it's an incredibly important topic in society. You know? But I think there's also probably other ones right now too that are people are interested in information on as well.

Well and, I mean, I think that somebody who's interested in the gender affirming care is gonna look for it. I mean, there it's not gonna be that it has to necessarily be dedicated. They're gonna go into our policy and look at what's covered, what isn't covered. They're gonna reach out to Dean. I mean, I don't think that, it necessarily needs its own page, but, as long as the information is available, those who are seeking that type of care would love for it. They wouldn't just

Otherwise, you could add a add a laundry list of all different kinds of things Right. That we want a specific link or

Why am I I typed it out. Some blanking there. Yeah.

I think you're going right down down the right path, Brian. And then all a sudden, it's like, well, they're having everything they have

in place.

And I get it. Having that spot is nice for

the company. Found I've served in county, and it would give me a broken link.

So, Marissa, this is Scott. To me, this kinda ties into the the sentence before. If if everybody is going to be driven to a portal that explains what their benefits are individually or for their families, I I think it would be included there, and there's really no point to having some general gender affirming care landing page.

To thank you, Scott. Does do all vendors usually include the full is it the member certificate? It's, like, the 80 page document that is that usually I mean, because we had an issue this year already with Gain when they did this transition. Then for three months, we didn't have access to that that document.

Right. But they the carriers have to supply that. Mhmm. And then I think with that transitions, we're seeing carriers, you know, combine and then make their their changes from one system two to one or what have you. Yeah. There'll be that blackout period, if you will, but they do they're required to have that information out there. I think way back when they used to be mailed to people, you know, and right? The trees. Yeah. The trees. Right. Exactly.

Alright. So Nate is now on this is our dedicated Dane County page for Dean that you can see, and so this is where I'll sometimes refer people for that advanced question line, which is there.

I'm just going back a minute to the, member certificate. Why do we not have that on our insurance page anymore? It used to be years ago that it was on there. And, is it just you know, because we have a spot for the HMO. We have a spot for the POS. Why would we not just post the member certificate on our website? Sorry, Amy.

Well, one I don't remember that we had the 90 plus page document out there, but we do always post the summary benefit description. That's, like, seven or eight pages for each plan and the one pagers, which is the high level overviews.

And the the the the SBC, the seven or eight pager is a a federally required document to deliver. Certificate's not required. It's kind

of a a nice it's one

of things if someone asks for it, if you give it to them or whatever or so, in general, that's kind of we see the see those things.

Mhmm.

You certainly could post it. There's something

over that one line and click here.

Right. So that is the that's the current, and it takes you just then to a general page, not Right. This is not Dane County specific. Specific.

Right. So that's the general page that every member of Dean Health Plan has access to and the the benefits.

And by taking that language out of a mandatory requirement, it does not impact coverage. Correct. I mean, the the care is still there. It's just we wouldn't be requiring

The vendor.

The vendor to to have a specific link or page for that.

Yep. And so you can still have the requirement of, hey. You need to cover this spelled

out in

Bellspring A

R F B. Right.

Yep. Which it is in Welby. Which it is. So is that line in the mandatory requirements? Nate and Jerry, are you hearing people you know, vendors question it or be confused about what that means?

I don't think it's a huge piece. I've been we're nibbling around the edges for something that would make it a little bit easier. Yeah. Just less chance of an underwriter going, oh, what are we doing here? We can't reprogram uhc.com to have this. Right. I guess I would lean towards striking that that requirement.

Yeah. I

I would agree only because it's not gonna impact coverage. Correct. We're not we're

not saying Yeah. This is

not because we're saying remove gender affirming care.

So right now, the conversation seems to be leaning to what Nate has here, which is putting this under the bulk of it under preferred and then striking the gender affirming care line. Mm-mm. Any other thoughts or counters to that direction? K. Moving on to six. Dender must provide data for compliance with GASB 45 in electronic format within thirty days of the county's request. I have no idea what this means.

So GASB 45.

So let's say it sounds like one that's probably because of a compliance issue.

It's gonna have to be in there. Chuck's got it.

I'll explain it. So first, we need to change it to 75 because the GASP stands for Government Accounting Standards Board. So this is a calculation that we have to do every year, and it relates to the kind of the discussion that we've had at yesterday's meeting, which is to what extent does including the retirees in our group affect rates for active employees? And there's an actuary study that require is required that that be measured. And so we have we've always had good compliance with Dean whenever we ask for this.

So, basically, we're gonna we need, like, a list of the census of all the retirees because we don't have that in our payroll system. And they've always been good, but I think we need to keep it in there just because it's a requirement for our financial statements. And if we had a different provider, maybe we wouldn't have that same kind of compliance.

K. So that one's sounds like it's green. Yes. Chuck, are you saying that we have data on the retirees and how much their inclusion is impacting our rates?

Just a minute. I've got f 30 fives flying over my house right now. Okay.

I've got the same one. You must live close.

It's tougher when the windows are open in the spring. They're a lot louder.

Yep.

Yep. What we have is an actuarial valuation. It isn't what you might hope it would be. It's kind of the hocus pocus of sort of what is the long term liability of what's being calculated. And the standard, a GASB 75, is more was developed and is more impactful for governments that actually pay for employee insurance when they retire.

So, you know, we it was really customary in Wisconsin school districts, for instance, to have teachers insurance get paid maybe till they're 65 or maybe even beyond, which is a very significant liability. In ours, it wouldn't reveal what I think the claims data that we get from Dean is much more informative, with respect to what we're what the committee has been interested in.

Okay. Thank you. Alright. So we're hearing from Chuck. This one should stay green. Any other discussion on it? Alright. Number seven. Payments will be made based will be based upon the county's payroll register and any manual changes made by the county. County will not reconcile with the vendor's paper register. The county will work with the vendor to attempt electronic reconciliations as needed.

I think that has to stay as mandatory.

Is there any changes or adjustments needed to it as written, Amy?

Off the top of my head, no. But I would need to probably talk to John Miller and Carol because they're the two that do this. But John Miller basically does a reconciliation every month of what we've paid in, and we just tell Dean, this is what we owe you and they accept it. We don't take a report from Dean and compare it to ours and figure out where all the differences is. They just accept what we send them every month for money. Don't think we wanna change that.

Right. Called self build. We have a lot of employers that do that for life and disability.

K. It's not standard in in in medical space, but you're gonna accept it. Yeah. There's friction there, but also, like, the benefit to the county and the HR team

and the

whole team is pretty significant, so I wouldn't wanna change that. Right.

And with DEP plus, WA, and Dean again, they've all done it. Like Nate said, there might have been a little friction, but

yeah.

Did we get pushback from any national vendors on it?

I'm sure we would have if they would have made further in the process UnitedHealthcare, Blue Cross, but WPS is you know, the the national players are basically, no. You're gonna do it our way. You know? And the local carriers are more open to partnering, I guess, I would say. I don't know if there's a better way to put it. I don't I

think that that's fair, and it is like it you know? I just don't think we wanna make that change unless, you know, put Gander Shaw, and that was the only bid there.

I mean, reconciliations the other way are a lot harder to to manage. Right. So what we're doing is we're saying these are the people that we have enrolled, and and this is what we're paying, and and that's that.

Any other thoughts or concerns or discussion on seven? Number eight, proposals should be quoted using carrier standard commissions.

Yep. And this is one that we asked to have put in there because carriers commissions are gonna vary all over. Nine a lot of times, carriers will say, hey. What what commission level should we use? We always work on standard commissions because I don't wanna be sitting across the table from somebody and they're saying, wow, Jerry. You're getting 7% commission. The standard's three. Why is that? Well, I'm Jerry and Blue Ram three. No. We've won business because honestly, because that's so, you know, for full transparency, we wanna make sure this is in there. So any and all carriers, it's their standard commission, and it varies. And Amy has

seen this in the RFP process. We still got lots of questions there because, you know, part of the considerations, we just don't wanna play that game as a carrier saying, like, are you getting 1% today, but, you know, we'll give you 2% and, you know, kind of hope you come in our corner and have some of discussions of of that. There's a period in time where, like, GHC locally paid three or four times the commission of other carriers. Yes. You end up in some different spots where carriers are trying to are make making their bids and kind of trying to manipulate the commissions to make it work. Mhmm.

So what is so when we're saying carrier standard commissions, the carrier is the health insurance the health insurance company.

So Dean, Delta, Standard. Right.

But who sets the standard?

They do. Each individual carrier does. And they're all very close because, you know, it it really, what comes down to it, if I and a competitor of mine bring a quote to to Dane County, they should be for whatever plans. They should be the exact same. The only time they're gonna be different is if somebody has higher commission in there because the commissions are built into the premiums. You have your premium rate is always gonna have commission built in by every carrier.

And what is Dean's standard commission?

It's a slight to be honest with you, the exact we don't have, but we have to we submit, to the to all of our clients every year a submission of here's the percentage of commission that we receive. And a lot of times it goes on a sliding scale for the first x number of members, and it goes down. But it's, you know, deemed the local carriers here are all very similar.

So I guess if I'm hearing this right, what it eliminates is the possibility of a vendor kind of undercutting by changing that commission level within the premium so that it looks like they're a better deal even though that could potentially come back and change. Right. Okay. And then we don't wanna be benefiting as the broker, you know, especially if, you

know, rough years, bad years, and, oh, it's got an extra 3% commission. No. That's not how we, m three, play.

So it sounds like it needs to stay.

Yeah. We like I said, we came we we requested that to be in here just for full transparency.

So looking back at last year, for the base of what we estimated for 2026, our total estimated commission was point 22% of the world.

I did that second tune there, didn't is Look

at you with insurance here, Virginia.

Point o 83%. What? Yeah.

I was I was just looking at the the BCD, saying the dentals is one point o eight three. You know, two.

And in all honesty, a lot of times, it's a I remember when I was growing up in the business, my mentor is like, you know, this 25 you never talk commissions. Well, why not? It's not a secret. And, you know, it's not voodoo. But, unfortunately, over the course of the insurance industry, there have been brokers out there that have really done some pretty nasty things. So that's why we wanna have that in there.

And how does this how does this play with the national provide vendors? National vendors pay more, to be

very honest with me, meaning at a higher standard. Yeah.

I think, like, UHC for 3.29%, I think, is what we usually see.

And are these are the standard commissions publicly available? Oh, yeah.

Yeah. They have to be yeah. They have to be filed with each state and, you know, and that's why I always blow that up, if you will, with client you know, even to this day of sometimes our CFOs that don't understand how brokers are paid.

Marissa?

Yeah.

This is Scott. So can I just ask a question? And and maybe the folks at m three can't answer it. But what would be the advantage to the county of not having this language in this requirement? I understand m three would like it in there, and I understand, I think, why. But looking at it from the county's perspective on what they're purchasing with this procurement, what would be the advantage to them of removing that or changing it? Can can somebody help us understand that?

An advantage?

Yeah. Or or is there not an advantage?

The one thing that I'm and this is just me kind of thinking this through on my own, and correct me if I'm wrong, please. I I think if you take this out, we kinda set ourselves up for the possibility of a carrier, like, putting in an extremely low bid by by manipulating that commission, and then we end up in another situation where the provider says, nope. We can no longer do this anymore. We're dumping you back when we were on p plus, and we went to WEA. So and and that is the only thing I can think of. But Right. You know,

in in that, again, the standard commissions are in there for, you know, if that's how we're paid. So the county's not writing a separate check or what have you to their broker. And I think

Amy could probably talk about this. We get so many questions on the RFP about the commission level. Like, we have this language about used carrier standard commissions in, like, four different spots. These are some brokers that look at this and say, well, you're getting paid, you know, point 22% now. You know, we can't go under that. And we just don't want that to be a decision point in the RFP at all Right. Of what what that is. Awesome.

Did that answer your question, Scott?

I'm not sure because I just don't really understand all the moving parts of the broker and the provider's relationship. So and I'm not trying to be difficult as I just was listening to this, and I'm a little removed by being on Zoom so I can kinda sit back and just listen to the discussion, I it just occurred to me that, well, okay. This sounds pretty standard, but should we ask the question, what's the county getting for this inclusion, and is it something that we, as the group that's been tasked by the county to some extent to explore whether there are better ways to do it, Do we need to just make sure we've done our due diligence in examining, you know, what this provision gets the county and that either there's no reason to change it because we think it makes great sense or, hey. Maybe there's a better way of doing this. And when I sit and listen and just don't understand fully what it is that's going on, that just leads me to to ask the question.

So I I'm not trying to to pull the string too hard.

No. It's a it's a it's a weird spot. But I think what I what I would say it gets the counties. It gets a guarantee that, you know, m three as your broker isn't doing any shenanigans to try and get ourselves paid more by one carrier on or another behind the scenes. It's saying we're gonna get the the regular standard amount, and there's not we're not going to go back to them and say, hey. I know you guys quoted this at x, but, you we really think we get you over the finish line if we can if you bump that up a little bit.

Well and the other thing I the other thing I think it gets us, Scott, is if there's no commission built in a contract where the vendor is actually paying m three to be our consultant and, provider, then Dane County really doesn't have a relationship with m three. And I will tell you, Shannon, myself, Carol, lean on Nate and Jerry a lot to do research for us, to deal with kind of high end issues sometimes that come up with our carriers. And without that commission being built in there and paying them for those services, we wouldn't have a relationship with them at all.

So I'm hearing it's a way of of making sure the procurement is above board and honest across all the players. And and then I would say, yes. It makes sense. But I until that really gets vetted a bit, I it it wasn't clear to me.

Well, doesn't this also put us on an equal playing field? I mean, the carrier is, like, more of an equal playing field? Yes.

And a lot of services that m three does, brokerage firms do, carriers used to offer. You you think back fifteen, twenty years ago, carriers did a lot of the services we did. So as m three has grown and carriers now take that away, that's one of our one of our many value adds to our clients is, oh, we still do that for you, but we're doing the standard commissions. We're saying, hey. We're going above and beyond in that, but that's why, you know, again, we just like to have it all. It's got above board. There's no secrets. There's no you know and that's how we are are, you know, earn our comp, if you will.

Does the county have a contract with m three?

Yeah. So

No. We don't have a contract in writing with them. They are they are m three insurance is our carrier or helps us with our insurance by being paid by the vendors, but there's no exact contract written from Dane County to m three because we don't pay them money directly.

Right. Okay. Yes. Thank you. So thinking of how we as agents get compensated in general, it's it's we have a unique system. But, essentially, we're we can be hired and fired by the county at any point in time. Correct. You know, Amy or Amy or the administration could sign a letter and say, we're making Joe Schmo, our our broker, effective this date, and it goes through a carrier. The carriers use agents for because someone of of their Salesforce, someone's outsourcing different pieces of administration. And, you know, because of insurance licensing requirements in The United States, in order to write insurance, it has to go through a licensed agent.

And so Jerry and Jerry and myself are all licensed in the state of Wisconsin. We get to do all sorts of fun stuff and solicit, negotiate, advise, and place insurance products. The insurance carriers require working through a licensed agent to do that.

Okay. So just to clarify, sounds so I understand, you know, I know the county has to go through an RFP process and contracting with other vendors, but what you're saying is that since m three is not directly paid by the county, there's not an RFP or any sort of contract

Correct.

For working with m three. And it also at the end of the day, as we've said before, to to us, it doesn't matter who the carrier or carriers are that you're with. We want are, you know, told to find the best possible fit for everything. So we are not beholden to one carrier or the other for the various reasons. Like Nate said, they say, hey. We'll give you an extra 2%. No. And, unfortunately, there are brokers out there that do that.

How much do the standard the carrier standard commissions vary?

Quite a bit. It's gonna it's gonna depend, as Nate said, you know, probably about eight ten years ago, GHC for new business was paying a flat 5%, and then they had to go away from that.

5% of premiums?

Of premium. Yeah.

And It's

a lot more than point two two.

Yes, ma'am. It is. At point two You know? And but we we've like, that's not gonna last long, and it didn't. You know? The national carriers, they pay, you know, they just always have. But I would say the local carriers we deal with, health, life disability, dental, it's gonna be fairly close on each one.

Well, just with health. Health, both yeah.

I think of the three, I think g still JC still pays slightly more than the courts are deemed. Yeah. And just generally appreciate in this market, so that's not what we get to live and breathe and focus on. It's let's get the right thing for our clients and figure out what's what's there.

Marissa, this is Scott again, and I'm sorry to pick at this so much. But just so that I understand, if there was a company out there that chose not to work with m three as the broker, would they be able to participate in a procurement?

Are you asking if they could respond to the RFP?

Yes. Yes.

They could. I mean, if, say, if usually, Scott, the only time that doesn't happen is if we are not appointed with those carriers, but, it's rare that, you know, most brokerage firms are appointed on the employee benefits side. On the property side, it's very different. Appointments are different. But on our side, say we're not and we've come across that more on the life and disability. Maybe we're not appointed with that carrier, then we do get appointed with them.

Well,

I'm just wondering if, you know, part of our issue is we need to have more competition.

Mhmm.

I just wanna make sure that by working with m three or whatever this provision, you know, provides

Yep.

We're not excluding potential vendors.

No. No. I can safely say m three is licensed with all the national carriers, all the local carriers for health insurance.

Okay. Thank you. Certainly, we never had a bid that didn't go through because of our our inclusion in it or anything in that space. You know, thinking of, you know, locally, we are the largest agent for the the local HMOs.

Yeah. Well, and don't you also play the role of encouraging people to bid on our book of business? Absolutely. So you're reaching out to carriers

Yeah.

You know, and trying to get them to to at least Yeah.

Consider. And if anything, you know, over the years, Zen three has grown and, you know, in our footprint, we have carriers that we're not maybe we're not as appointed with. They come to us and say, hey. We need to have you appointed with us.

And from the the the client perspective, it's use it is useful to work with a broker that has good relationships with the carrier because Mhmm. There are edge cases. There are situations. You know, the fact that Jerry has the bat phone to go to Andy Ohalek to go to leadership at at Dean.

Another highly used insurance term.

To he would say, hey. You know, there's a fire here. We need you to jump at it. And, also, we have our leadership that can do that. That's a benefit. We see that up as a bigger deal on, like, the life and disability side of when we're writing cases. And I I our CEOs had this conversation with us is, you know, you can write with whoever you want to. We're not gonna force you to go to our c two carriers or preferred carriers. But keep in the back of your mind, if you have one case with, you know, Joe Schmo, an insurance company versus a 100, our ability to work with them and for them to, you know, push gray areas into a state of our clients and escalate it Right. Is better when you have a bigger business.

We have had to have Jerry and Nate, step in and help us with issues with health insurance and taking it to the top and the same thing with task now that we're, you know, working with them on our on our COBRA stuff and flex. I mean so they've been very helpful in being able to get a response to things that we might not other get otherwise get.

Thank thank you all. I I think it should stay green then.

Thank thank you, Scott. I appreciate the questions. I am curious if you and I'm sorry. We're not, like, I think, hanging up on this one to have having anything to do with with Nate and Jerry here, but I think it's just one that we don't understand very well, and so it's helpful to to dig into it a little. Yeah. And we get questions on it, frankly. Mhmm.

And that's why we have no problem ever talking about it. If somebody does, that might be a.

Here's a question. Is this a standard sort of mandatory inclusion for other big local then It's

a it's a I guess I would call it a given. It's it's just you know, if if if an employer has a broker and they're not in so if Dane County is not paying us directly, commissions are gonna be automated. Like I said, all your lines of coverage have commissions built into them. Say you say you do this on your own and you are not you don't have a broker, the carrier is still gonna have the commissions baked into that premium. They just keep the dollars.

So I

guess the answer is in every RFP that we write in or we're doing them ourselves for our our our private sector clients, we're spelling out the commissions. And so we for all Jerry's clients, we're saying standard commissions. Mhmm. And we'll still get carriers that come back and say, yeah. But it's at 8% today or, you know, it's at this percent. If you come to with us, it's gonna go down. And our response is, that's fine. Yeah. We don't wanna be in this position where we ask the client to pay us extra because of who we are.

And we started working Nate and I started working with the city of Madison two years ago, and we're in the process of sending out an RFP on their life and disability life and wage in July. And but we've had to explain that because the prior relationship, you know, they never knew anything about it. Like, here's how it goes. So it's it's it's more common, I think, to have these discussions with our clients so everybody knows our best interest is for you guys or any client. Fill in the name of the blank with the client.

Is this similar to real estate when they've been dealing with, like, the standard 33%?

I I don't know enough about the standard. Yeah. I I would think any any sales brokers or what have you that work off of or investment, it's always a percentage of something. You know, for ours, it's it's it's you know, with the commissioners are baked into the premiums. Real estate, I don't know enough to I know the yeah. There I think the three and three on what whether you're selling with buyer, that's the start and stop of the extent I know. Yep.

Other thoughts or questions on number eight? And how long has the county worked with M 3?

Well, let's see. When I was Heather at Dean, Kevin gosh. That was in '97 to 2001. So I'd say probably from mid nineties or so. And then I started M 3 in o one and then took over the county the end of o six. So a long time.

I didn't know you were Heather a dean.

I was. I was a dean for five years,

and that's when I

Alright. So we'll move on unless there's anything else. Alright. Moving on to mandatory requirements coverage. Alright. So this is the a list, but it's not all inclusive. Right. Number one, coverage quoted must match or exceed those currently enforced, and potential reductions in coverage should be outlined in the RFP response. Please see current certificate attachments for coverage details. So this is plan design.

Mhmm. And so this is where we get into some of those things of a hundred and two day, you know, prescription supply and the Rx and getting to the nitty gritty of that. And so that that is certainly a pain point from providers. They have their kind of they're set in their ways, but it's a benefit to member. Shannon's always talking about that. Well, we could get a free month essentially.

Yeah. Yeah.

Free month. Yeah.

Well, it seems like there is an out in this language where it says that any potential reduction in coverage should be outlined. So it's not that we wouldn't let someone participate in the RFP process if they didn't exactly meet or exceed. But then So so do we just need to figure out a way

to to reword this? Yeah. And then that will be reflected in the grading as well as far as how they're rated.

Right. Preference would be given to I'd Correct. I don't know if I'm wanna move this whole thing into preferred because I think that this is important. I just think we can maybe rework the language a little bit to make it

a little more palatable. We change must to

I agree I agree with that. I mean, when it says must match every you might just get some people who look at that and say, you know, we're not gonna do we do it a little differently, we're not gonna waste our time Right. Prepare you know, it takes a lot of energy to put one of these responses together. And when it says must match, under mandatory requirements, that could easily be interpreted to mean if you don't submit a response that matches, you will be thrown out because it's a mandatory requirement. That's the way mandatory requirements generally work in purchasing is if you don't meet it, you have to meet it, or you get thrown out.

So I agree we wanna have come as close as we can, but to put it in is a must. This is probably one of the things that is the most important to try to expand our

Yeah. The playing field.

Can can I chime in with a

a question on this language real quick? So, is there a way that we can put language in here that says something to the effect of as closely comparable as possible so that we're give a strong indication that we don't wanna we don't wanna diminish the level of benefits, but recognizing that there are changes in how companies are structured, trends in the industry, whatever that might not match what the last contract

included?

Is there is there a way to have that language where it's, like, as close as possible, essentially?

Yeah. Yeah. So I I

Yeah, Jay. That's exactly what I think we should do is is have and and it kind of says that here where it says, well, if you have deviation, you know, list those. And and so we need to soften that where it says must match. And so it could be something like the county strives to, you know, to maintain, the current benefits in force to the extent that your proposal deviates from those explicitly indicate where those variations occur, something like that.

Could could we just make clear that along those same lines that responses that do match are likely to have the best, you know, evaluation, but the vendors are free to propose innovations or, alternatives that meet some, but not all, of the requirements. Something along those lines to make it much more explicit that there's some flexibility there.

So what what we have done in the last two RFPs is we have put a grid together that has basically five different health plan options. The first one is our current plan design, and we ask vendors to put down what the premium costs are to manage that exact same plan we have. Then there are other options like what you all saw last year where we had the the b and c options where the co pays were different, the emergency room out of pocket was different, the deductibles were different. We put some examples specifically in there and had vendors bid those as well. Then the last option was a vendor, you tell us the best plan design you think would be best for us and the premiums, and that's what we've reviewed.

So I think this wording could be changed to basically have the vendors fill out those kinds of documents, and then we would just evaluate them.

So, Amy, when you're reaching that level of of, I guess, communication with the the vendor who is potentially going to engage in the RFP, is that already a step past where this has been put out? Is it is that kind of information given when the RFP process goes out, or are they just getting this language with the must in there? And then some vendors may not even bother contacting the county to get that additional information of, well, what we would expect is to have, you know, our current plan quoted out, whatever you guys feel might be, you know, a better option for the vendor, you know, a b and c option. I guess what I what I'm concerned of is if if the initial RFP put out is just this language that we're seeing in front of us, how many carriers don't even bother to, I guess, ask additional questions?

It's not. It's actually an attachment to the RFP.

Okay.

So down in below, I Nate has it down. It says attachment a is the actual spreadsheet that would have all of these plan designs on there, but it's an attachment from the get go of the release of this RFP. It's not something they ask for after the fact.

Okay. Is

is there any

way Yeah. We're and this is what's confusing a little bit is because Amy described it. We have these different ways for them to respond with plans that do not meet our design, yet here we say you must.

Yep. And so

Yeah. I think we just need to change this wording to say, complete attachment a on the different plan design options we're asking you to bid on.

So Could they submit a bid for some other type of plan that we don't have listed? Sure.

Well, the the fourth or fifth option we've had on there has been a blank slate, and they have filled it out. Okay.

Thank you.

Yeah. So I would like to say it a different way, we've we we're basically asking them, hey. We want you to quote what's happening today. We want you to meet or exceed current coverages, and then we're asking for a couple of alternatives that are a combination of, you know, increases or decreases. So, like, in years past, I don't have the options going forward in front of me here. We looked at some of those changes that we looked at in last year with some deductible co pay tweaks to see where that pricing came in. We also said, hey. We want you to quote us if you're offering GLP ones for weight loss. It's one of the options we had last time as an enhancement. And then we had the last one of carrier preferred option of saying, hey.

If you think there's something that'll be a really good fit for us, we'll we'll entertain it.

I think

Dean is the only one that gave us anything on that last time around. But that was a thought of, like, hey. If someone wants to come in and just say, HSA, we're gonna give you this incredible deal on this rate, we'll entertain it. I just threw some proposed language there to soften this. Like, looking at this first sentence, which I agree it's because a little in figure out a coverage quoted must match or exceed those enforced and potential reductions in coverage should be outlined. I like flipping the should and must in that sentence. So coverage quoted should and maybe, say, meet or exceed. Yeah. You see those currently enforced. I added a a caveat for in network benefits.

Mhmm. That's more of a pain point on, like, vision Yeah. And some of those other plans where it's a little more canned. And then the potential reductions in coverage must be specifically outlined in the RFP response. So we're saying we'll give you the leeway to not, you know, meet or beat what we're doing today, but you darn better They'll that can't talk. You darn better tell us about what you what you're doing.

If there is reductions. I like that.

And then I I

I

don't love my I think the service could be cleaned up here for reductions in coverage compared to those enforced will reflect negatively graded. There might be a better way to

reference.

A better way to say it, but right. It's because yes. And that's the thing. Then at least once we have the proposals, then they know what they're submitting. Okay. Should meet, meet, or exceed, and then they would assume grading is, you know, okay. If we're not gonna meet this, well, could that drop us down into ranking? You know? So, yeah, quotes for current coverage that meet or exceed offerings are Because,

I mean, when we're grading the RFPs, we have no idea what what the cost is.

So we're Right. We're looking at the benefits first and that yeah.

Yep. Yeah. I like that.

And then the scoring is I don't remember how much of the scoring lands here. Does anyone remember offhand?

Honestly, it's, like, 65, 35, so many things. It's the Cost has the bulk. No. The the response is the bulk. Oh, the response is the bulk.

Sorry. The cost

is 30 yeah. 35. It's, like, 35%. I have to pull what that number is.

Now, Nate, you just mentioned the in network benefits, particularly for in network benefits, but then you mentioned vision. But if we're just dealing with health insurance here, is that relevant?

Sure. Health insurance.

Have a vision exam.

Oh, okay. Yep. Under health.

And, see, I I was thinking more of, like, the two vision RFPs with with that comment. Yeah. I just always like to focus on just zooming folks in on what we're really focused on Yeah. With the network piece. That that language might be superfluous. I'm trying to I can't think of a good example.

I'm just thinking POS versus HMO. Right. And so that's where I was getting.

Yeah. And so, like, an example there would be there's the in and out of network benefits with the POS plan. Right. And generally, we see out of network is two times the in network. I wouldn't expect a carrier to deviate from that, but some of them might say we wanna see more steerage and and come in and come in there. Yeah. Generally, when we're doing comparisons, the the out of network, I wanna say assumed, but it it plays it's the backseat to the in network coverage that, you know, 90% of folks are gonna use. We could certainly remove that particularly for in network benefits and just make it shorter and more to the point of coverage quotas you need to exceed those currently enforced and potential reductions in coverage must be specifically outlined.

Oh, yeah. That's nice.

I like that better. Yeah.

And then just one other suggestion in the last sentence there. I think we could eliminate the first current. So quotes for coverage that meet or exceed current offerings, so we just wouldn't have the current in there twice.

Thank you.

It's hard typing when everybody's watching. Start a sentence.

Not sure where it's gonna end yet.

Yeah. But Okay.

And then I had another question about this, and now I forgot. You mentioned for so I you know, we're all familiar with plan design, and we all know kind of the big ones. But then you just mentioned some of the more minor or smaller things, lesser known things. How many of those are unusual, such as, I think, the

hundred hundred The pharmacy one is the one that

really jumps out. Yeah. Jerry, can you think of anything else that

What about the no co pays for kids? Is that a common one?

That's not.

It is getting there.

So getting more common?

It is getting less common less common. So, two years ago, GHC came out and said for all of their nonunionized groups, they removed the ability to have a $0 co pay for kids Yes. Because it is technically age discrimination. Now it is age discrimination under the age Reverse is It's weird. Yeah. In favor of children. Yeah. So it's but, you know, their compliance team came out and said, like, we're pulling this back. I I worked through this with another local client that has a unionized environment. We said, no. No. That's that's part of the Yep. The negotiated settlement with the union. We can't change that. Yeah.

We're not about to do that, and they were okay with it. But that's a that's a good call out of and I don't think so far, we haven't seen courts or team take that stance. That was GHC being a little bit aggressive on the compliance side. But, yeah, I guess, the $0 co pay for kids and the the hundred and two day supply are probably the two.

The the cope the there's there's a

degree of separation there. A hundred and two day supply on pharmacy is a is a much bigger difference than

the My thought is that probably was in play at initial inception because I think you guys may know better as others. I think when Dean first opened their doors in the 8182, '83, somewhere on there, I think the county was one of their first big clients. And that my gut my gut tells me that one o hundred two has been in there since on the show.

Or 01/2004?

I think it's hundred and four, actually.

Yeah. Sounds right.

Or it's

a 30

sorry. 34 supply

Yeah. Versus 30. 302.

Hundred two. Okay. Sorry.

Okay. Carry the one.

It's an

extra month a year.

Yeah. Good. So I I

think that's just been in there since they it's I think. I don't know. But every other carrier has not had an issue with it. What meaning p plus, w a

What about nationals?

Nationals probably would say no.

What about nationals and the zero co pay for kids? Most likely say no.

I would have to go back. We can we can take that as a follow-up to see if, like you do I ask our our UHC rep if they're still quoting those plans? So I'll I'll make a note of that. Yeah.

Just And I'm not trying to be negative Nancy. No.

I want I am you know, I think we there are things that we've done because we've always done them, and there's things that are benefits that Mhmm. People have fought for. And, you know, the hundred and two day supply, Shannon knows this one well, but there's a lot of people that don't even realize that's an option.

And the doctors are always checked. I mean, my doctor still to this day say, yeah. You're that one. Yeah. Because I don't think people do use it, and I don't think there's any other insurance companies that do it. Yeah.

Right. And I don't feel like we have prohibitive co pays. But knowing what some other people have for co pays, it it it could be that someone makes a decision not to take their kid to the doctor because of a prohibitive co pay.

Yeah.

Or or just waits longer than they probably should have. I I mean, they may still take them.

And then a better urgent care or the emergency room.

Right. But aren't our co pays for, like but aren't our co pays, like, $5 or

$10?

That's what I'm saying. Ours is not a prohibitive co pay, but that I mean, who knows if if we got a a different quote from a vendor that changed that design where now all of sudden we moved away from a $5 co pay to a $50 co pay, could we have somebody who would wait much longer than they should to take their kid to the doctor?

I think that helps us with that fifth option that Amy was talking about that, okay, Carrier, give us what you think would be a good a good, you know, plan to have. And then, okay, current to that, what's the cost differential? You know, does it make sense? But you also, you know, make a very strong point too.

I mean, the the prescription, the, you know, the the extra benefit of that is nice. I mean, is it necessary? I guess, I would say probably not. You know, it's it's an extra benefit that if if it made a difference whether somebody would bid or not, I I would certainly think that we would all say we'd rather have the competition. Yeah. And that's me saying that after all these years of protecting that benefit.

Like feeling alright?

But it's one that where we get we do receive with the county, and and we'll receive questions from carriers on what is this, like, the sale? Because nobody's really done it.

But this is you know, so what we're the language is would allow somebody to alter that. Right? Because we're saying It

could be a deviation that they would deviation. Yep. That they would explain.

Right.

Okay. Other are there any other provisions besides those two that have been kind of you've gotten questions from

Those are kind of the big ones. Yeah. Yeah. Outside of that, I'd say no. K.

Alright. Any other kind of thoughts on number one

here, or are we moving on?

Good.

Number two, proposers must have where are we? Proposers must have capacity in their health care networks adequate to accommodate the county's members. So access. Mhmm.

And that, again, that that has been one that has not

Most recently, GHC. Yeah. Yeah.

Why did we we're using vendor everywhere else and now Proposer. Is there any reason for that?

I don't think so.

No. Those are interchangeable.

Marissa, could we include a provision that just allows that they either have to have the sufficient capacity or a detailed plan to get to the capacity within a certain time frame so that it's clear that we're we're not excluding people that don't currently have the capacity and are open to somebody having a workable plan to get there in a relatively short period of time.

I think that's a good option to add in there that if they don't have it currently, how do they plan to be able to comply with that?

By the beginning of the contract.

That's what was gonna ask

if

you wanna if

you wanna

answer that.

Yeah. I mean, we they they need to be pretty persuasive about how they're gonna do it. But, again, we're just trying to get more responses. And we may look at their plan and say, jeez, that doesn't look feasible that you're really gonna get that many more doctors. You know, we can't say, yeah, six months after the contract is signed because if they fail to do that, we're in a real world of hurt.

Right. Yeah. I mean, I

could see us, you know, getting to the when the coverage is gonna start and them not having done what they said they were gonna do and and then what then what? We rush to get a carrier and pay a lot more for coverage.

Right.

I I agree with all that, but I think this also puts Dean on notice that we're open to exploring working with somebody other than Dean.

That's all. Yep. That sounds good.

What do

you guys think of that?

I see standard be able to call the detail. Yeah.

I like it.

Alright.

Think you found me in the past.

Great. It's upset.

Any other feedback on that one right now?

Just Marissa, I would say we need to put some time element in there, to define when it is that we would want that capacity available.

I think he has proposed effective date of coverage. You Do you know? Want something more are you suggesting something different than that?

Just in that second sentence. Maybe it's implied, but it it I don't know. Maybe it's maybe it is good enough, I guess.

Okay. Is that is that better, Scott?

Well, I yeah.

I think if we're asking them to provide a detailed plan, yeah, it needs to be at the time of the quote. So whatever the RFP deadline date is would be when they're required to have that detailed plan to us.

Right. But the plan could be if we win this by the time we start in three months or whatever, we're going to have the capacity there.

Right. And that that's what's in the first sentence. It says networks must accommodate the county's members by the proposed effective date of coverage, which would be 01/01 of the year.

Yep. Wouldn't it be subscribers?

Yeah. Yeah. You could change members to subscribers.

Oh, well, members, but that's everything. Better than that.

Just subs subs is members is belly button, subscribers is employees.

Oh, okay. I thought it was in reverse.

And I I don't think there's any any issue adding the, you know, by the fact that they're just making it really explicit.

Mhmm. Good.

Good call.

Yeah. After all the work.

Sorry. Maybe I

can't watch that, but just