Homeless Issues Committee - Regular Meeting

08:30. We will call this meeting to order. This is a meeting of the RFP subcommittee. Linda, we can start with you calling role.

Linda,

do you wanna do that, or do you want me to?

Go ahead because I I wasn't ready for that part.

Okay. Sorry. Amy, please.

No problem. Marissa Barack. Here. Brian Tischer.

Here.

Shannon Meyer. Here. Scott Drummond.

Here.

Amy Jutsig, here. Jay Brower.

Brower here.

Tommy Rylander.

All over here.

Everybody's here. You have a quorum.

Bye. Thank you. Have think we have perfect attendance at this subcommittee. So thank you all for well, pretty close to it at least. Thank you all.

Alright. So I think we wanted to get started today by looking through I realized I don't have the agenda pulled up. But I know we wanted to look through the meeting, the mandatory requirements Nate had sent out to everybody.

So, Marissa, do you need to do a minutes review of the minutes from April?

Thank you.

Yeah. I'll get

you on a pull up here. Thank you. It's the seventh. Right there. Well, thank you. Or right there. Either one. Alright. Did anybody have any adjustments to the minutes from April? And the motion to approve the minutes from April.

So moved, Shannon. Second by Tisha.

All in favor of approving those minutes? Aye.

Aye.

Great. The minutes are approved. Thank you, Amy. So now we can go back to our first action item to review the mandatory and preferred list for the RFP. We were able to go through that whole thing last time. Nate, thank you for sending it out to everybody so people could review it at home. I know there were a few things some of us were gonna follow-up on. I did send Nate, some gender affirming care language that he was able to, pop in there today that we can go over. But maybe we just start at the top and see if anyone had any updates or new thoughts on anything.

Kira was on vacation, so I haven't gotten back with her about the electronic ability to do the in the Dean portal. Okay. So that's I'll talk to her. Just got back from Colorado.

We had two I did have some conversations with, you know, folks at Dean. Okay. Just high level about, you know, some of some of the different things in mandatory requirements. And that was one thing they mentioned was, you know, the county is a group that they do allow a lot of processing for do a lot of manual processing, and there's nothing in the plans. But you they have to kind of buy that at some point, Medicare is gonna push back about streamlining the systems and kind of saying we'd use the portal to submit things for this paper and some of those things, but that's not not now. But

Can you help us understand, like, on this, which ones that would apply to?

So that'll be number two. The minimum must accept paper enrollments desired by the county for for that language. You make that just

a bad thing.

And that's one we were putting on a preferred list.

So I think we're going the right direction there. Thanks. I mean, I just wanna get

the history of why we're still doing it and find out Yeah. Why it wouldn't be in our best best interest also to change because we're we do have a lot of keying errors on their end. And then person has to come back to us, and then we have to reload the form, send it again. So, I mean, there are reasons that I could see it would be advantageous, but I don't know the back history of it. So You know,

maybe Amy can speak just from you know, since I've been working with you guys, that's that's how it's been, but I think it would be very advantageous to probably save a lot of time on both sides. You know? But I don't wanna Amy, don't if you can add more to that. I mean, it's just you know, Carol's always done it that way.

Well, I think part of the issue too is that it's also her knowing what to keep for their cost. Yeah. So it comes to her. She sends it to Dean, and she loads it in our system. Yeah. So it's a matter of if they do it on the portal, how fast are we getting your information back. So I think we would have to see that before any decision could be made anyway.

Yeah. I don't really

have much to add other than it's always been done that way. And I know I do know Carol has mentioned in the past that her sending things electronically, that she's always having issues with her email, not being able to encrypt stuff because it has Social Security and date of birth, that IT fixes it for her, and then it doesn't work. So I think that's one other reason that she's just always done it manually as well.

But if if they were to key into the

portal, it would be secure anyway.

Right. Right. Yeah. I'll

I Shannon, I can try to shoot Carol an email while we're on the meeting and see if maybe I can get some more detail from her while we're here. Okay. And I'll copy you on. Perfect.

I meant to talk to her on Monday, but she didn't stop in my office as normal.

Yeah. And and we got a

little busy on Monday as well. Yes.

Got it. Nate, does what you're talking about apply to anything else, or was it primarily two?

It was primarily two. The other one that was kind of in a similar vein was the thirty four day pharmacy piece that we talked about there. It's It's kinda being, you know, truly kind of out of the norm.

Could they provide us with any data of how many people are actually taking advantage of that? You can ask. Because I think most people don't ask. Yes. And I think, you know, like, my last physical, I forgot to say it. So this time, I'm on ninety day instead of a hundred and four days. So Okay. Because it's something that's not normal. So I'm just curious. I mean, if if a lot of people are using it, that's one thing. But if it's just a handful, I mean, is it worth losing a bit about? I don't know.

Yeah. That's a good question. And, yeah, Dean could definitely give us that information from yeah. Just

Shannon, I did the same thing as you. My script right now through mail order is only ninety day because I never mentioned the 102. But I have a note to myself to mention that for sure to my doctor when I renew.

Yeah. Yep. It's like every other year, I seem to forget. Yep.

Where is you know, so I was so that's the thirty four day would not be here. And I don't wanna get ahead of ourselves if we'll get to it later, but I'm thinking that might be kind of part of number one under mandatory requirement coverages. So will we get to that there?

I believe so. I believe so. Okay.

And I'll hold. Alright. So we've talked about two. Amy's reaching out to Carol. Any further comments or thoughts on number 3?

4? 5. 6. 7.

And that's related to what we were talking about before with the paper.

Is that something that Medica's gonna start pushing back on? Is that what you're saying? Set seven?

Potentially, just with the the reconciliation process.

Yeah.

There wasn't a hard It was yeah. It was more just

Yeah. Share so and Sherry Boss, the head under it, was in our meeting yesterday as well. And Heather was just like, down the road is they can date Medica and Dean continue to come together. There could be some changes, but she was it's gonna be as of this date.

You mean as far as seven goes or

in general? I I think just kind of in general what what Nate was talking about earlier. I mean, basically, it's, from the standpoint of, you know, pain as is that that I think that could continue. She was just kinda giving us a heads up. This could come down the the line. I don't think she's trying to alarm anybody. K.

I mean, because I'm not so should I agree that, is it two and seven aren't necessarily tied together? The enrollments are what we have in our system and not really I mean, yes, it's almost like

a separate build. Still be

based on that even with the portal. So I don't think the two are tied together. Mhmm.

Can can I ask a question real quick to dive into seven? Can someone explain the this process? So the county's got a list and Dean has got a list, and this element of the RFP is saying we're gonna go off of the county's list. Doesn't make a difference what Dean has. Why would those not match?

Well, technically, they should. Sorry. I'm jumping in here.

No. Please go ahead.

Technically, they should match, but, when we have somebody out on leave, for example, and we can't pull their portion a of premium, there might be a problem. They might be, off, so then that has to be reconciled. I think the issue is is that, when once we enter someone into the system and premiums start being made, since we're paying those premiums, we expect that those people are gonna be the ones covered regardless of what if Dean hasn't entered them yet. Or or if we take somebody off and we're not paying the premium, then it reduces our, the amount that we're to pay even if they haven't taken them off. I think some of it's timing so that the, it's like as we know the information is put into our system and, therefore, ours is what I would consider more current and more accurate.

And, let's see. Why would why else would we do it that way?

I have a you know, you and I and Amy, and I think I may have included Nate and Jerry. I can't even remember. We were having a discussion about why remember, got new information from Dean with their numbers, and it wasn't similar to our numbers, and I couldn't figure out why. And I was asking everybody. I'm thinking about that now, and I'm wondering if the Dean numbers have everybody from COBRA included.

They may have.

Yes. Because COBRA

They shouldn't now because that's task. So that that shouldn't be any part of our

Well, would they would have them listed.

It was still part of the overall county.

Oh, right. Right. Yes. But previous to task, we did it ourselves. So they would have been Right. Right.

But would that be a reason why

That could be more.

Is kind of important because we are not paying for people on COBRA. They are paying themselves. And so Dean is still including them, and we don't wanna be billed for them if they're paying directly.

Right. And we have had some issues. For example, we just, Friday, I had to clean up a person who they were trying to go to the doctor. No. We got a letter from Dean saying their coverage ended as of, April 30, and they were, as a retiree plan because they hadn't made their premium payments. While they've been on COBRA this entire time, and task was making the premium payments to Dean, it ended up that it was a error on Dean's side. So here, they're gonna cancel these people, but they've been making their payments regularly through Task. So we did get it fixed, but that also could impact something like that. Yeah.

And was included on that on that report.

Oh, they were split out? Yeah. Never mind.

I mean, I I don't know if it's worth belaboring, but if number seven is a friction point for Dean, is there some other, like, mechanism that we could introduce to resolve these incongruences between their list and our list?

We would have to do a reconciliation, and we do that with other things too. It's just one more labor intensive piece of work that would need to be done by somebody.

And it's it's not uncommon for employers and carriers to have discrepancies, you know, on a monthly basis. Not I don't mean that's badly, but the timing is is that, you know, and this just always been, hey. You know, it's kinda like a self bill for groups on life and disability that they will carry your here's who we have enrolled. Here's what we're paying you. And at the end, you know, they do try attempt to electronic reconciliation as needed. And, but, again, I think this is one of the things that has just kind of always been in there. I'm not saying because it always has it should be.

Yeah. I guess I to your point, Jerry, with the, know, the county will not reconcile. There's paper register or work to do electronic reconciliation as needed. I don't know how that plays out in practice for that. I believe there's there's some low reconciliation. You know, Dean's not mailing a paper bill. Right. To be reviewed. So it's Howard treating the paper versus electronic piece of that.

I I think the way that the billing actually works is that John Miller does a spreadsheet. The check goes electronically to them, but I think John sends that spreadsheet to someone at Dean so that they have the proof of why we sent them the money.

Right. I think you're right. And then I think they also include on that spreadsheet, like, people who are on leave or in an unpaid status, I believe.

Yeah. John has it all in

his I mean, is this is this is really for the county's convenience. The reason this has always been in here is so that we don't have to spend the time do the reconciliation. But it's kind of unusual in in sort of financial practices to say, we're the one who decides how much we pay you. In other words, so, you know, we're telling the carrier that if you if they have more people enrolled than we have in our payroll register, we don't pay for those people. Yeah.

You know? So I can see where this, you know, isn't in the it's not it's sort of way on the county's favor in terms of a a procedure, and I could see where that wouldn't be possible and and maybe a little bit of an anomaly when carriers look at how they handle other, you know, other groups. That if that's the kind of thing we're trying to minimize, you know, and be a little more conventional that this might not be the best thing to keep in here.

Yeah. And that that gets to the to the crux of my question. Are there any adjustments we can make here to get a better price?

I don't know if it leaves a better price. I mean, it just sort of looks like you know, may I I don't know if this is something where some carrier just wouldn't bid because this is too strange for them. I don't know if it would change the price because, you know, there there's always reconciliation, like Shannon said. I mean, you know, we have people newly enrolled all the time. They haven't.

Sometimes that doesn't always get communicated back and forth on you know, like, right when the bill is due. And but it's a little you know, this is this is it's it's definitely saying reconcile to the vendor's paper register. Well, there's probably not a paper register anymore. I mean, it's electronic now. And because it's electronic, reconciliation wouldn't be that diff you know, not it wouldn't be impossible.

And I guess it would sort of you know, in in cases where I've been involved in this or in the in these kind of details, but it's been a long time. You know, if there was somebody on the carrier's bill that we didn't, we would notify them, and then we take a credit the next month. And then if there was somebody we had on who they didn't have, you know, we would, you know, get a charge later or something like that. So there's a kinda a constant reconciliation on the margins of the size of the group. But it isn't like there's hundreds of people that are on this reconciliation where they're not getting paid, you know, for dozens of people every month.

It's really on the edges. New people come new starts, you know, new terminations, you know, people on leave. It's like it's all on the edges. So, materially, on a you know, what's approaching a 95 plus million, you know, dollar a year contract for insurance, you know, it's kind of on the really on the edges, bet, in terms of the amount. But it's you know, we could just not have something like this in here and or have something more like, you know, we will not as a mandatory requirement, but have it later in RFP that the carrier and the county will agree to a, you know, to a monthly reconciliation process and leave it to kind of what's what what what's the best practice that we can come up with.

Yeah.

Thank you, Chuck.

Can I just add a couple things?

Sure. Please.

I do think also we do the same exact thing with dental. We don't reconcile the dental bill either. They just accept what we do. And I can say from my own experience in the past, we actually do reconcile flex plan every pay period, and that's only a a couple 100 people and you have to get the report from the vendor, run the report from our system, compare the two sheets where they're different, then go research and figure out why they're different and do all that. So I can say administratively, if we add health to that reconciliation on a monthly basis, it is going to increase someone's workload to have to do that with 2,600 names on the list.

Yeah. Well, I think it'll also be more difficult if we stay with the with the faxed enrollment because I think

Right.

That's where we're gonna have time issues all the time. So I think one has to kinda feed the other. It might be

Yeah. Of the two, the the paper enrollments versus the portal is gonna be the the carrier's bigger piece, I think. The reconciliation process, there's some I don't see wiggle room. There's, you know, some language there. We'll work with you to do that. Right?

Could what about number seven becoming yellow and striking the middle sentence of the county will not reconcile? So then it's number seven becomes yellow, so it's on our preferred list, and it's basically say still saying the payments will be based on the county's payroll register and that the county will work with the vendor to attempt electronically reconciliation. It doesn't, you know, box us into a monthly or quarterly time frame.

Mhmm. Amy, what do think about that?

I think that's a great suggestion.

Yep. I agree. Will you leave it there and make it red so we know which one, please? Thank you. Any other comments on seven?

Great. Eight. Any comments on eight? Alright. Down to next.

And I did this morning, Amy was able to send over attachment a Yes. If anybody wanted to see that because it's referenced here. So I guess my question is about this. So we're talking about the coverage quoted should meet or exceed those currently in force. Mhmm. And then we were mentioning the thirty four day supply. I didn't see that here. So is that and I don't see the no co pay for kids here. Is that elsewhere in the member certificate that they would be finding?

Yes. So that's where you have kind of the high level summary that's not gonna reference everything, just the attachment a, And then there's the other language. Yeah. Must meet or exceed current offerings and, you know, see the certificate for coverage details. So that's where they're seeing $0 for kids, different piece of pharmacy.

Well, if

we were willing to kinda be flexible on specific things like the $34 co pay, how can we include that here? Or is that not

Julian, it's gonna be in the the SBC. That's one of the summary benefit description. That's one of the attachments of the RFP.

I I would say when we change this from saying that that coverage quoted must meet or exceed to should meet or exceed, I we kinda soften that language here. So we did build that in. But they'd have

to explain deviations from So that's where they

would be expecting to come in and say, hey. You quoted a thirty day on the pharmacy. That that needs to be spelled out.

So the only thing I was thinking with that when we talk about that we've changed it to should meet or exceed, and potential reductions in coverage, the way I read that, it would make me think that I'm not necessarily going to have to provide an option that meets or exceeds. I just have to give an explanation of why I'm not. Right. I think for us, it would be better even if it's going to be more expensive to see an option that currently covers what the county is at. So we would be making sure that anyone replying to the RFP would have to at least include an option that is current.

And then Whatever that cost would be, and then they can also add on their other carrier preferred options so that we could we could see a comparison of both. And then if they

if said carrier decides not to include one meeting, you know, that would be affected in the grading

per se. Yeah.

I agree because I'm concerned that we're it's just gonna become very difficult to if you're not comparing apples to apples. Right. So

And that's actually one of the reasons we put together that grid that Nate just had up. We had, like, those first two columns were our actual plan design, and we asked them to put the numbers for cost there. But then we also gave them a couple different options of, you know, different price points for out of pocket deductibles, the maxes, the co pays for office visits and specialty visits. And so we wanted to put something specific that they had to bid on, again, to try to compare the apples to apples versus let letting them just give us whatever they thought. It's really hard to compare those, but the last option on that second page of that worksheet is actually a, hey.

You give us what you think might be the best deal, and it's kind of a blank slate.

Yeah. Right. That's option

five. Right. Four

or five.

Yeah. 4 or 5.

Kind of the opposite. You know, Ryan, like you said, we wanna see one as is. Mhmm. Here's some other and then, okay, Carrier, what do you think a good plan would be for us to take a look

at comparing contrast? Just so that the language we have in here is clear that they should be be providing one that is our current coverage.

That was how we framed so you're looking at the just 20.4 current benefits and current benefits with changes kind of as we went through it. You guys have different language you wanna see in that document.

Yeah. The only thing that I've been trying to think of how to word this, I guess I would say something along the lines of coverage quoted should include an option that meets or exceeds the county's current coverage. Other options that don't meet this requirement should be specifically outlined in the RFP response.

Sure.

So splitting it into two sentences to be more clear.

Yep. So it should.

Seats. Yeah.

So make that in the first sentence. Card quoted should provide an option that needs to receive those currently. Or

And then just start a separate sentence. Is Yep.

That include natural reductions, coverage, and stimuli response. Yep.

Looks good. I like that.

We wanna say reductions, or do you wanna say alterations or adjustments or something?

I think, I mean, if if they're making something better, they're going to highlight that. Mhmm. True. Yeah. So I kinda like to focus on if you're just saying really specifically, if you're making it worse, it's due to you you could, but focus on productions make sense. Yep.

Any other comments on one there? Alright. Two, we had some additional words added. Any comments on 2? 3, urgent care. Any comments? Four, wellness program. We were putting on the preferred list and then kinda striking this the specifics for a 150 and just saying adding adjusting three to four.

Correct. Do for number four, wanna add this sort of saying, like, spell out these programs in detail.

That's why. But Because they'll they'll some will be similar, but there will be differences between carriers too. Sure.

Good call. Mhmm.

Alright.

And then the gender affirming care section, I was able to check with somebody who helped rework that language.

What's this this language you have you have here? So

the new language the news proposed language is in pink.

So make it gender affirming care instead of transgender. Yep.

So it's striking transgender and just write writing gender affirming care. So I think one and two are pretty similar to what was already there.

So we wanted to include transition care and just go to gender affirming care provided? Yes.

That's pretty similar to what was already there. So I think the main difference is number three.

So I think the, like, utilization management policy.

Yes. I don't know if Nate or Jerry is better able to explain what a utilization management policy is.

So, basically, the utilization management is kinda like case management. Cares are

gonna have all kinds

of these different things. You know? So if somebody is going through a number of, say, conditions slash conditions, You know, they may have to an extreme a caseworker, but utilization. So making sure that all the different care that they're receiving, the care will have somebody working with that individual to kinda make sure all the information is getting, say, to their doctor or internally so, you know, they don't run into any potential, blocks or or, claims being denied for, oh, we don't have this information.

And is that I mean, I remember talking about this at other IAC meetings. So it seems like the dean health plan slash medica currently has, as I recall, something. Yeah. So is this language that is gonna be a barrier to anyone, or is this seem like standard?

Yeah. It's standard. So every carrier, p plus, WEA, you know, Dean, whomever, j c, court, they all have it. You know, u u m, utilization management, or, you know, member managements, they call different things, but it's all, yeah, it's all gonna be standard for carriers. You know, every carrier to have that type of program. They may call it something a little different k. But it it's the same thing.

And then can you go back up, Nate?

So I was trying to pull up I was trying to pull up the actual, like, utilization management policy that that. Oh, there you go. Sure. This goes into detail of. The history of. No.

I was just gonna go back to what the proposed language was if we give this one. Edit. I saw for number three. So if you give us utilization management or policies, Could we make it and or? Because if they have both, you may as well get both. And slash or.

Yes. What

are people's thoughts on this change? Okay. That was good. Mhmm.

This is just my OCD speaking here. But I have that too. In in section five, just above the gender affirming health care benefits Mhmm. Since we're striking all of number two, should three then become two?

I think it's all. Yeah. It's

all

getting struck and replaced with the pink.

Oh, okay.

Got it.

He just redid it.

Gotcha.

Alright. So then we can move on to the medical weight loss. Well, no weight. Number six. Excuse me. Alright. So we're putting that under preferred. Yes. K. And then determine final location that needs note to us for later. Is that correct?

Yes. K.

Any questions on that? K. Then we have the seven medical weight management services. We struck all of

this. Mhmm.

Alright.

Did you skip over wellness section?

No. That was up above.

Yeah. That's up above gender. Yeah. From here.

That's right. We had talked about moving that to the Yeah. Preferred list.

Yeah. I actually, I think, had emailed back some updated language to Nate and Jerry, basically striking that whole thing that's on the screen in yellow and red and just basically providing an overview that says something like Dane County currently maintains a wellness program for members and request vendor support to remain a key component of future health insurance offerings. At present, the county receives 50,000 annually to fund wellness initiatives for Dane County members. These funds support county wellness programming administered by employee relations, which currently manages the program on behalf of the county. The contract also currently provides a healthy living program sponsored by the vendor that allows employees to earn up to $150 for participating in wellness related activities.

As part of the proposal process, Dane County asks vendors to clearly explain the wellness funding they are prepared to provide, the structure and administration of their wellness incentive programs, the types of rewards available to employees and eligible dependents, any reporting engagement tools or support services including included with the wellness programming and any additional wellness resources or innovations the vendor would be bring to Dane County. Dane County is interested in proposals that not only maintain current wellness support, but also demonstrate how vendors can enhance employee independent engagement, promote healthy behaviors, and add value to the county's overall benefit program.

Amy, can you resend that language to me? I do not see it in my inbox.

I will resend it. But I kinda thought it might be better as, like, a statement of here's sort of what we have, and we just want you to tell us what you might or might not be able to do versus the way it's actually written.

Yeah. I'm checking for it too. That makes sense.

Alright. So, Amy, you have a proposed paragraph instead of bullet points is what I

I do.

K. But you're still proposing keeping it on the preferred list?

Yes. Yeah. Not moving it. I just wanna reword it.

Okay. Well, maybe once we're done today with this, we can get a new one sent out with your proposed paragraph and so people can review and see how that looks. Fair? Mhmm. Sense. Okay. Is there anything else people wanted to circle back to on the mandatory slash preferred requirements? Otherwise, I guess I would propose that we have Amy send Nate the language you just referenced. Nate could up you know, add that paragraph, leave in the old one so we could still see it, though. And then

I just emailed it to Nate and Jerry.

Thank you. Thanks.

It's just pop plopped right in an email.

Yep. No. That's perfect. And I like the idea of a statement versus, you know, them being able to do anything with it, so to speak.

Good. And then maybe next time, we can finalize this.

I can pull it up right now. You you just send it to me.

Yep. I got it too. Oh, excuse me. I

think that makes sense. It it was maybe making it non mandatory, add some context to it. Right. A good build around it.

And then whatever with the carriers that propose, you know, they can in in light, as Nate said, when they're doing things better, they like to talk about it, but then they can kinda mention, in addition to this, here's what we as a carrier also offer. Kinda makes it make it easier from a rating standpoint too. The coffee's kicking

in. Mine isn't.

We wanna add a bullet specifically asking if they're willing to to fund the the program at current levels. So you're saying, will you get us $50,000?

Scroll back up. I think I was thinking that first the wellness funding they're prepared to provide, I would think if they were prepared to provide exactly what we have, that would be that answer in bullet one. I mean, you could say, are you willing to provide what the county currently has? Yes or no.

But then if you say if you put it that way, they're just gonna say no, and then will they propose what they want?

Right. I don't know. Yeah.

I mean, because if they came in and said, we'll we won't propose 50,000, but we'll provoke

But we'll do 25 or we'll do the healthy living portals, but not actually give you funding to do other things.

Right.

Because they're gonna know what's currently being provided. Right?

Yeah. Because I explained it in the first paragraph.

You guys think it was a green I think Amy's right that that does ask the question. I I could see someone not picking up on we you know, it's like, are we prepared to provide, I e If I'm willing to current.

Or With that in pink, I can't read it at all. So

I mean, I'm just going basic well,

you read it. So, I mean, I feel comfortable with that. But I just it's it could be my eyes or my glasses. I keep on. No. I'm I'm

I'm there with you. It's a little.

Well and I do see, on the page that Nate's on right now, right at the bottom of the bullet points, there's that paragraph again that says Dane County is interested in proposals that not only maintain current wellness support, But, again, that doesn't say our current wellness support. It just says, like, basically some sort of wellness support. So, yeah, it certainly could be reworded if other people think that it's not capturing what we're asking them to answer.

Yeah. I think I I understand where you're going. I think we can probably tighten it up a little, But I think I get the overall shift. So thank you for doing that.

Well, I can leave it highlighted, and we can tweak it if someone has suggestions.

Yeah. I think if we can email it out, we can Sorry.

No. That's fine. Yeah.

I have a hard time reading it on the screen too. Okay. Not just you, Shannon. So thank you, Amy. Yeah. And maybe what we do also is actually move things onto a preferred list so we can see how things look too.

Yeah. Maybe it'd be helpful if we do kind of accepted changes. Here's what a new edited version would look like without all the tracking of the mandatory and preferred and then kinda start from scratch, but keep this one as a a draft.

Yep. I like that.

I should be able to

send a two birds to that then. She's good. Okay.

Sounds good. That's a Kabura move. She'll give you a track change one and edited clean version so it's easier to read.

That is nice. Alright. That sounds good. So, Nate, you're volunteering to do both then? Yep. Great. Thank you. Alright. Any other requests for changes or edits to this before we let Nate do that and move on? Not that you have to do that right now. No. But

I'll use a bigger screen. Okay.

Alright. Great. Thank you. So we'll hopefully be able to finalize this next time. So I think in our balance of time here, we were gonna start a discussion on self funding to be continued tomorrow for those of you attending full IAC special meeting tomorrow.

You guys are getting sick of this. Right? That's where you say no.

Yeah. No. We'll see who can get tired first, Jerry.

Oh, well, last two people standing. No. Yeah. So we're gonna have our guru. Brian's in today. Right, Nate

or is Yep. Brian Meyer. To I would better I would reach out to him when we're ready for him. Yeah.

Okay.

Great.

So he is a tremendous underwriter, an underwriter, if I may say, with a great personality. That usually doesn't happen. But we're gonna try to keep it at a high level just from the standpoint, and I hope this comes out right. You know, it's very easy to get ratchet on the axle. Really the the point of this will be just talking about how the coverage is funded compared to today. Benefits, everything else, we're just gonna look at. Everything else stays the same. This is just a a way the county would fund it versus, you know, they become the health insurance plan.

Yep. So

and I don't mean to but it's just self funding can be, you know, very, very deep. And so we're gonna try and, a, not bore the hell out of you guys, but also just kinda get the idea around. And Brian is very good at it. You know, Nate and I, we live and breathe this every day as well. And if we get into our acronym alphabet soup like we may sometimes, just say something, and we'll try not to.

Fair.

No. We appreciate it. I think our goal is to try to learn as much as possible about different options. So and I think we're gonna run till 10:30 today.

Yeah. And Nate and I, we, yeah, we have enough. We're back to back. So not that we're trying get rid of anybody.

But wanna make sure we're all on Yep. People understand, and then we'll pick up tomorrow again.

Perfect. And, really, our hope is to go through this pre this presentation again with the larger group and kind of shape it and tweak it based on feedback from today.

Sure.

Make sure that things are understandable and we can elaborate, expand on things. K. Thank you. Heather did confirm she's gonna try and pull see what they can get for reporting on the pharmacy question of of those things. Thank you. Yeah.

You said the person coming his name

Is he coming down? Yeah. Brian. I'm sorry. Brian Weber. I said Brian Meyer. Excuse me. We have two Brian's.

Okay. No worries.

It's a popular name.

It is. Yeah. We have three Brian's now. Here, I thought Jared was a popular name, but apparently not.

The sheriff's office class that I started in, we had four Brian's all in the same class.

Oh, okay. Oh. And are all four still there? No. One is. No. I think I am the

nope. Two of us are left. Two are gone.

Two Brian's still standing. And how long have you been?

Since 1998.

So Just a couple years. Yeah. Awesome. Since '88?

'98.

'98. '98.

There's a UHC, Raj. I already see him on Milwaukee whose name is Nathaniel Yanki. Oh. And, like, it was the weirdest thing. We jumped on a call, and we're Two and eight Yankis. Both, like, gingers with, like, red facial hair wearing black sweaters. We're just

like, uh-uh.

This is very strange.

Did you find your doppelganger? Yeah. Seriously. Like, he spells his name with a his last name with a y instead of j.

Pronounced the same way. Like, he was

Like, there's two Nathan Yankees. I guess it's better than two Jerry Browns. But ladies and gentlemen, Ryan Weber, hello.

Thank you for joining us.

Of course.

I thought we were an underwriter with a tremendous personality too.

I didn't know those existed.

So Oh, exactly. So, again, as in all the meetings we'll have, you know, we'll we'll see there's a lot that we're just really focusing on the difference how the plan is funded versus sell or fully insured today.

Yeah. So this presentation starts off with just some definitions and terminology to make sure we're on on the same page of certain things. We talked about stop loss before, but to define it, it's a contract established between a self insured group. An insurance carrier of buying reinsurance claims exceed a specific dollar amount over a set period of time. There are two types of stop loss. There is the specific stop loss in the aggregate. Specific is on an individual number. Aggregates on the overall population. And stop loss represents your paying premiums, transfer risk for claim you know, for claims that exceed a certain amount to to the insurance carrier.

And just quick question. Are we gonna be able to get the

PowerPoint? Thank you.

Other pieces here, you know, a t p a or third party administrator. Since we are contracting with to essentially act as the insurance carrier. So they're, you know, collecting premiums, paying claims, providing administrative services. That's something you're hiring a company to do that for you, so we are self funding, you are establishing your own insurance company.

So the alliance would be an example of that?

No. The alliance is a network. Correct. Oh. An example of a TPA would be, like, Oxygen to be UMR, would be Prairie States, O'Brien, etcetera.

Yeah. So I think the difference would be the alliances, the company that talks to the private providers directly. They're the ones that make those contracts. So you Okay. Get billed for whatever a thousand dollars for a service, and they're the ones that contract and be like, we're actually gonna pay you $600 because of all the business we're gonna be directing towards you. Third party administrator is more gonna be we are gonna get all of those claims, gonna send them to the alliance to work through their process, and then we're gonna pay them. We're gonna take the money out of your account and give it to the provider so you don't have to. They're gonna field the calls to your that your members have on whatever. Like The administrator fields the calls. Correct. Yep.

So they they feel like insurance company. So you're gonna need to get insurance card that says, you know, UMR that might have you group name on it.

Yeah. So very similar when we went from p plus to WEA. Yep. You know, new ID cards, you had access to all of the local providers. Very similar on the self funded side, but, again, the alliance is gonna help you with discounts. One thing to note there, Brian, I don't wanna steal your thunder. So as an example, deed providers are in there, but deed is not gonna give the alliance, or the network as deep of a discount as they will give them self. So in Brian's example, it's a thousand dollar claim. If today, Dean will say, oh, we're we're gonna allow and pay 250. Under self funded standpoint or with the alliance, they may say, well, we're so we'll give you a discount, but it's gonna be 500.

Right. But right now, when we've got POS and HMO, while back so we've got some people that are going to other places Correct. At a higher rate.

Right. And Dean is paying those claims even though they're out of network. They're paying at the usual customer, and what Dean feels would be suitable as if it were in network, the member then pays the difference.

But in some ways, self funding is more similar in terms of experience by a member as when we had WIA.

Right. Yeah. To the employee, there's they're not gonna know the difference of fully insured or self funded. K.

Other items here. So lasers are, you know, the the coolest thing we have to talk about in insurance. It but it's a it's a a risk transfer mechanism similar to stop loss where you are purchasing a or or you're making a decision to ensure a specific member that is expected to have higher cost claims at a different level. Yep.

No. That's perfect. So, basically, this is a way for you to say you know your employees better than what the stop loss carrier is telling you. So you're gonna take on instead of a $100,000 for this individual, you're gonna take on $500,000 or whatever that level might be because you wanna take on that risk. You don't wanna increase your premium or you know something more about that risk, whether that be they're gonna be off a plan next month.

They've talked to you for some reason, and they're like, this condition's over and done with. So it's a way to transfer premium to claims because at the end of the day, the stop loss carrier, just like your current fully insured carrier, they're not gonna pay all of these large claims if they know they're gonna happen. So it's a matter of transferring additional transfer of risk based off of knowledge on that. Does that make sense?

Is that at the time of

It'd be at the time of renewal is when so we can write contracts where they can't add lasers, and that's something that we most likely discuss, or we can include them, and that's where we can negotiate. But it'd be upon renewal or signing of that stop loss contract, they would say, hey. We wanna place a laser on this individual. They'll give you a reason why x, y, and z they have something going on. And then you can either accept it or, upon renewal, you can either accept it or decline it. But

So I'm trying Oh, Shango.

No. I'm trying to understand this. So I'm remembering with prior presentations from Dean, we sometimes get a list of kind of the top 20 Mhmm. You know, basically, people that are running the highest bills. Is that relevant to this?

It could be depending on the ongoing nature of them. So if you have your largest claim is, say, a million dollars, just throwing a number out there, and they're like, we know this person is gonna be a million dollars every year because of whether it be pharmacy or whatever it might be. They're gonna say, we need to either increase your premium because we're not gonna take on all of that liability for that million dollar claim, or you can take on that risk is basically what this is saying here. So it's gonna be more of the ongoing nature of large claims versus one and done hits.

But this is primarily the people that are kind of run driving up the bills as opposed to Brian does a good job exercising. We're gonna lower his.

Yeah. Yeah. So to think about it, you know, a little bit different way with you we've always been assisting you. Think on the fully insured side, there's the confusion between the contract that's signed with Dean, it's a three or a five year agreement, and the annual renewals here. When you're self funding, if there's there's really that annual renewal process, you might have multiple year guarantees on some admin fees with your TPA, But the stop loss is going to be marketed and renewed every twelve months.

And those insurance carriers are taking a really deep dive into your point, the high cost claimants that have been high cost claimants as well as new emerging conditions. So they're diving very deep into the claims to try and figure out how much premium or money they think they need to bring in in order to accept the risk at a specific deductible level. And a laser is a way for you to kind of modify the risk that they're accepting based on information you have or preferences. Because the idea, if you don't do that, if you'd say we're doing a no new laser contract, they're gonna build that premium into the overall baseline premium. And you just know you are paying that.

Whereas there's circumstances where you have that million dollar claimant, but you know that, hey, they're dropping off the plan or, you know, the third or say they're in hospice, you don't expect them to make it to the next plan year. You as an employer, rest of the insurance company, you know, self a self fund insurance company get to make the decision to say, well, we can budget for that person individually or we can just put it into the baseline rates.

So not having a laser allows you basically to spread out and even out your costs over the year. While if you have lasers, then it could potentially go down if somebody falls off the plan for whatever reason.

Correct. Or it could go

up if somebody I mean, can they add them midyear if somebody suddenly has a No.

It's each it's each renewal. And then we will work you know, Brian works with all of the Nate and I myself and Nate's, you know, in the company to determine what's the best in the best interest for the group, you know, spreading that risk across the entire population or if it's let's see what that looks like with one laser or two depending on how they are.

And, like, who's on some life?

Well, if there if there could be multiple per person, there could be you know, on a group of your size, it wouldn't be uncommon for a cure to come back and say, well, you've got these seven. We've seen the high cost claims as an example. So they laser in on individuals. So if all of us were a group, it could be where Nate and Jerry are gonna each have a laser.

But the employees don't know this.

Correct. Right. It's it's it's all behind the scenes. So the employees, they don't know about this. Right. But it's it's as far as that risk risk management for the plan for the group continuously.

And the laser is part of the stop loss Yes. Contract. So we've now got three different agencies potentially.

We've got

the stop loss insurance, the third party administrator, and then the network.

Right. And not not too confused that there's gonna be a fourth

one

to administer your pharmacy benefits. Yeah. Okay. So pharmacy benefit manager or PBM will work alongside all of those K. To administer to detail your pharmacy benefit, to detail what's covered, what's not covered, where does everything fit, and what tier. So do you pay it, whatever, $20 co pay or a $40 co pay, that sort of thing. And so similar to a network where they have those negotiated rates, the pharmacy benefit manager has those negotiated rates for the prescription drug side of things.

So do you see the the laser more in smaller companies because they have more knowledge of their employees or or generally because, I mean, how do you make that decision? I mean, because When yourself I know what Joe Smith's health concerns are.

So as an example, when we see the high cost claims when we review them, there there are certain people in the in the employer that will have access to that, but it'll drill down to exactly who that person is, what's going on, what's the prognosis, how long will this be going. So when you're self funded, you have all the claims detailed by every member.

And by who accepts it, that's gonna be very much the risk tolerance of the individual company. Okay. We've got groups of as low as 75 enrolled on the plan that are like, I really don't know a whole lot about what's going on with this condition, but I'm willing to risk on, like, take that risk and that we have groups that are thousands of employers that are like, I don't want that risk. So it's totally risk dependent, and there is no one way one one benefit one way or the other. It's more risk tolerance and how are you feeling about the instability of the cash flow that could come with some sort of decision

like that.

Thank you. That that does hit on something too just in general. When you're fully insured, all the PHI and the claim information is kept at our own flanks from team. They're giving us purely, you know, a a number. There is no not anything identifiable on that. It's just a high level. Here's some claims that are in your group. When you are self funded, there's the ability to cascade that information. And, know, you're subject to a much higher level of of HIPAA coverage Yeah. As an entity because you have access to their names, dates of birth, conditions, medical notes for the people that are being treated. That's not everyone. Everyone has access to that, but the self funded company does.

Makes sense. Okay.

And that's something those large claims are discussions that we have upon renewal. So we don't bring up details, but there is, like, you've got this person, that sort of thing.

Gotcha. And when we have a case, a group that is self funded, we so Brian's area will receive the same claims feed that the employer receives. So we are able to see all that detail as well, which helps us with the monthly reports we send out and things like that.

If you as close to it or far away from that data as you all wanna be. That's part of our job too is to make sure we're that person that can deal with any issues and then make sure you only see the information that you wanna see.

I I would not anticipate any of there would not be that information coming to IAC in terms of Yeah. Level that would be, you know, things inside the administration. And then people like Jerry, Ryan, if we're designated to be able to access to that as part of our

So sort of like FMLA. It's a need to know basis. Correct. Exactly.

Last piece on the slide is just talking utilization. So think experience. So wonderful. Next slide is kind of a definition of what is self funding. Trying to put this in front of the definition slides, but, you know, it's an option for any health care where there's some opportunities for for cost control.

There is more risk being taken when you are self funding. So it's risk reward calculation. Today, you are paying Dean known premium for twelve months in order to accept the risk to cover your population. When you're self funded, you are setting a rate saying we think it's going to cost us this much to to ensure our population. And if you run worse, so think that loss ratio is, you know, above a 100%. At that point, you were losing money. If you run better, you're building a reserve.

And then Brian and his team and us will work with the employer to determine what your funding rates or what your monthly premium is.

Other pieces here. So, you know, the employer is responsible for funding medical claim. We talked about that. You're paying those as they come in, and getting reimbursed by stop loss carriers as after they work through some different processes there. You know, if you if you run if you run good, you can you can benefit from it. If run poorly, it doesn't work out so well. There's some cash flow benefits in that. Especially when you first go self funded, there's a little bit of lag before the claims actually hit. It's you can think when we see reporting from from the end, usually sixty or ninety days old. It takes a while for things to get processed.

There are a significant number of plans that are self funded. Ryan, you would add anything else to that?

No. I don't think so.

I think that.

It's an interesting the last bullet point, more than half of employer sponsored plans in the market today include some form of self funding. What does some form mean?

So I would say there are I think what this means is there's layers of self funding. So we're talking about at having specific stop loss stop loss protection so that you technically, you're only self funding up to a level for each member. There are groups, think Amazon, Nike, any of those super large companies that are just like, we are gonna take on all this liability. So they are truly self funding the plan. They are paying everything from the first dollar for their members to the 10 millionth dollar for their members should they have those.

So the some form of self funding, I think, is that full range of how much are you taking on as liability, whether it be a small group of 50 enrolled that takes on $35,000 or the Amazons that take on everything for their employees employees is at least some form of self funding is what I think that definition is.

And then that green bullet at the bottom is also worth noting. And self funded plans are governed by ERISA versus fully insured plans are are governed by state mandates. So it's like you're kind of reporting to a different section of the government at that point. You're subject to regulation by the federal government versus the state.

And, technically, self insured employers do not have to follow state mandates, but they generally always do. Because US, the plan, can determine, do we wanna cover this? Do we not wanna cover this?

Are the reporting requirements significantly different than two? I mean, like, for a resire, you're required to report at a much more detailed level than you would if I mean, fully funded plans. I'm assuming Dean does what we need that done.

Well, your third party miss yeah. So, again So the third party will act like Okay. As against that, I always use the fist, comparison. You know, you pay that monthly premium for Dean. You open when you're fully insured, when you're self funded, as Brian said, you have the third party administrator, you have the pharmacy benefit manager, you have the network, things like that. So it's today and Dean right now is doing all that behind the scenes, but to to you guy, to to any client, you just pay that monthly premium.

Right? So there's potentially a few more a few more things as far as administration that you have to do just depending on what TPA does. Like, the the one that jumps to mind is there's a pharmacy reporting piece that's out there today as part of the the CAA. And right now, Dean does 90% of it. They reach out and want to break out of, you know, of of premiums versus the company employer versus the employee dollars and what that looks like.

And then they should file a submission. Not all TPAs will do that. So there's there's different verticals to the. So to Brian's point about some form of self funding, I think the slide speaks to that where you're looking at kind of the spectrum of different funding mechanisms where the the far left is fully insured, where you're fully transferring the risk, the internal term of premium. Level funded is something we see in the really small group space generally, like, under a 100, where it's kind of modified form of self funding.

Captives are a a very popular funding mechanism, primarily kind of in the small to medium sized groups, but it's becoming more popular in big groups where you're purchasing stop loss with with other organizations. So you get you're and you're doing some additional layer of self insurance with those folks to reduce where your your spec level sits. Probably not the route we would recommend for a group of your size, Brian. I completely agree.

Yeah. I think having the autonomy of a group your size, you you wouldn't you'll get the benefits of being self funded in a captive about the size of the captive. So you'll have the ability to market your stop loss to work with different individuals for your plan and have some sort of stability outside of captive. So I don't think that's something that we're gonna explore for your size, as Nathan.

Partially self funded is what Brian alluded to. You were self funded, but you're purchasing that stop loss from insurance carrier. So you're retaining some level of risk, but also transferring a lot of it. Far end of the spectrum is being self insured, is being purely self insured where you're absorbing all of the risk. There's no stop loss. You're on the hook for every penny of claims.

The other counties in Wisconsin that are doing self funding, would they be then in that partially self funded? All of them?

Yeah. Yep. School districts, municipalities, yes.

K. What's I mean, is there protection in the law that, for individuals who have health conditions? I mean, what's to stop an employer from firing Exactly. This is the advocate

in me. No. No. No.

But I know but

I know they don't advocate that, but it's again, you're gonna know self funded, whoever the HIPAA privacy officer officers are, you know, everything. And has that happened? Not that we're aware.

There's no law, though, that says Right. You're protected.

Okay. Well, mean, there's there's protections for the use of personal health information for US an employee. You can't be be somebody can't fire you because you have cancer in your expensive claim. Correct.

Okay.

But that is against that the reason. That is against the law. But that's also one of the the concerns when you go self funded. And I think back to when the state was evaluating that, and that was a, you know, a concern that certainly folks had because there are people that have access to that information. And the firewall isn't even if it exists in in the law, it should exist in the employer. It's somewhat a transparent one to to members.

Right.

Okay. Alright. Right. Yeah.

Thank you. And I tried to be negative, but it's Yeah.

No. No. I wanted to

answer it.

Sorry. I got it. Thank you.

Oh, and and that's a that's a good call out, though, especially in, you know, sort of environment to go, well, just adds that extra layer of, did I get fired because I'm sick or every time I'm high I'm an expensive client.

And,

you know, today, Dean's not gonna tell you this person's there. Maybe HR is able to figure that out based on the usage and other protections that are there. But in theory, if you're self funded, you have access to all the information.

Yeah.

Well, if you're fully insured, the risk is on Dean.

Correct. And a lot of times, the HR departments that we work with with various size employers are gonna have a pretty good idea of who you know, if there's something major going on.

Thank you. Mhmm.

So this is restating a lot of things we talked about in kind of a table form. So starting at the top left as it relates to rates, you are fully insured. The carrier gives you a renewal rate to accept or reject based on the benefits that is, you know, locked in for a twelve month period. In self funding, there's, you know, a calculation that's done. And those when you get to pick the rates based on expected claims administration costs, that's where, you know, Brian's team does the omen's work to do a funding forecast to go back and look at, you know, two years of claims information and say, we're gonna apply trend to it.

We're going to add in all the fixed costs and say, we think it's going to cost x to to to cover your population for the coming twelve months.

So they would be able your team would be

able to do that for Dane County? Correct. Yep. We would say we would come up with what we call premium like equivalents that you can then use to set a budget to set the employee contributions and all those things. It's gonna be a budget because everything is based off of what your actual claims experience is, but it is a calculated budget.

So that's basically, like, an estimate of how much the incumbent needs to put in their bucket for CELRECs. Mhmm.

And so that's a that's a big difference from today. We're not only are we fully insured, we're used to having not to exceed that are previously negotiated. So we're able to budget ahead for a number of years to say, worst case scenario, we're gonna be paying x plus y. And we know that where it's self funded. Do not know what's gonna be what that would the recommendation's gonna be for more than a year. And, I mean, you

know, that's just gonna be a a budgeted estimate. It's could very well turn out very differently

Right.

In the next twelve months. It's not a not only not a three year guarantee. It's a not even a twelve month guarantee because weird stuff can happen with that. So

And how long would it take m three to come up with an estimate like that, like, timeline?

We could do it with whatever data we have at the current time. So we should have data through January most likely here shortly. Ninety day. Right. So we could do it at any time. The hard part is gonna be we can get, TPA proposals, pharmacy benefit manager proposals. The hard part is gonna be the fixed cost of that stop loss. So that's gonna be a little bit delayed. We can get estimates right now, if that's something we wanted to explore, but that's gonna be the limiting factor on when we can actually get a true estimate of what that

cost is gonna look like.

Would be the stop loss would be kind of the big question.

Yep. Yep. And how

much are we how much are we how much would they want in premium to transfer that risk?

And we're not gonna be able go with the stop loss number until ninety days out from We won't have a

firm number for ninety days. We we can get estimates before then, but the hard part is with all of these changes is especially stop losses, you can't lock in until ninety days before.

But in theory, if somebody was going self funding, you would need to do multiple RFPs. Correct? Like, one for the stop loss, one for the third party administrator, and then one for the network, and then one for the pharmacy benefit manager. Correct?

And there's ways you could consolidate some of those, but, yes, it would would be multiple RFPs. Don't know how that would look in kind of the normal purchasing mode of the county.

K. No. I'm just trying to trying to understand. And then but in terms of m three's ability to help provide estimates, you could provide some ballpark estimates on some of this at least.

Correct. You know, we we could look at the way illustrate from this once everything to be about this for a PPM, for the for the FTPA. You know, we can make it some assumptions about stop loss, but, again, those would be assumptions and illustrations and not Sure.

Guarantee of anything. And just again in terms of, like, time frame, if the county were to request m three to do that, would that be a two week project, a four week project? How big of a project is that request?

Long. Yeah. I mean, it's month few months. Okay. You know, because it's really a lot of times when we work with employers, our first goal is to help them determine what their risk tolerance is. You know, when you're looking at, you know, a CEO, CFO, controller, you know, here, it's the county administration. What is what is that risk tolerance? Because your claims are gonna be your claims no matter what type of funding we have. We're gonna have good months. We're gonna have not so good months. Yeah. It's a, you know, it's a very long process. But it's one where I mean, we've talked with some clients and prospects for five or six years, you know, as far as I'm trying to determine what their risk tolerance is.

No. That's helpful to know.

Yeah. I

mean, we can do an an estimate, but that's again, there's the level of accuracy there, and that's always a concern. If you say, well, it's gonna be this. Everyone's really excited, and then proposals come back after running an r p process, and they're 30% above that. Don't build a small. Yep.

So would there kind of be, I guess, for lack of a better term, like a rainy day fund, like, in times where you're gonna have lower claims that is set aside then and held so that in a year where you have higher claims, you've got some buffer, you set up a reserve fund, okay,

which will I know we'll be

getting to. Okay. And, generally, first year going self funded, we try and we recommend being pretty conservative where that sits so you have the ability to build that fund. Mhmm. That's also a tough bill to swallow though. It's gonna be seen Sure. While we're you know, 20% funding increase. So we have a 5% cushion versus expected. Yeah. Next on the table, we have a carrier under fully insured.

There's one carrier for administration and claims payment. When you're self funded, there's, you know, flexibility in the carrier partners for administration, for stop loss, and then that gets into the pharmacy side. You have a lot more different vendors in play being self funded, whereas, you know, right now, Dean is coordinating all of those things for you, which is nice because you're able to go to able to go to Heather and have have a responsible person to get all the information versus herding cats, chasing down different people and iteration is not always in the way we wanna see.

Could I ask you, is there is there an occasion on which people get enough or or organizations get enough money in the reserve fund and then they decide to take on more risk because they have that reserve fund? Like, I assume those companies that that give give out stop loss and lasers are in the business of making a profit and therefore are charging us more than they're giving us back ultimately for mitigating that risk. Can we take on that risk? Or are we just too small for that?

I would say there is a level of risk tolerance that you can do to increase that amount of risk that you do take on. And I would say that is proportionate to we're gonna set a certain level if you were to make that transition from day one. And then as that rainy day fund grows, you there's different things you can do to it, but increasing that risk tolerance is one of those things.

One approach we see there is when we do a funding forecast where we're breaking out all the costs, we have seen groups essentially say, hey. We want to draw down from that reserve funds. You build an expected dollar amount in. Tricky part there is trends always coming in, that continues to grow. You've seen that within the ETF plans on the state level where they buy downward. It's really expensive over time. But, yeah,

you can purchase you can purchase different levels of risk as you go on depending on your experience.

Plan design, you know, when you're fully insured, those are a little more in the the canned space. So getting back to kind of those RFP requirements you've been looking at and talking about and breaking down a, you know, a thirty versus a thirty four day supply on pharmacy. Ding County has been able to get more than to go fully insured group. I don't think we have any other groups. And three, they have a thirty four supply.

Mhmm. They supply it on on the pharmacy side. That's very unique benefit. In general, when you're self funded, you have the ability to do more unique things assuming your TPA can administer it. I had a group that had an office that had benefit built in where the first $220 of charges incurred on an office visit will pay in full. And then after that, it went to kind of the regular cost sharing piece. And that was a very manual process that was really painful, and the TPA kinda had to stop doing that because it wasn't it wasn't well adjudicated. So there's there's limits to what you can do, but there's just more flexible. Reporting, you you can hit on when you're fully insured. We're gonna get that high level report, some of these loss ratio information.

When you're self funded, you're able to drill down, you know, to the the member level, to the cohort level where we see what's going on in your population, which is useful if you're trying to do, you know, roll out really targeted programs. Today in fully insured world, you're using Dean's programs that they've looked at and said, here's the six vendors we wanna work with for various conditions. When you're self funded, you're able to, you know, kick off your TPA's menu, but you can also come to them and say, you know, we have a number of your kidney transplants. We wanna contract with Renalogic to to really target that program on more due to diabetes programs. And the last thing on here is just claims payments, whereas in your fully insured, if you run well, the carrier gets to keep that difference.

If you if you run poorly, they're all they're also on the hook for it. Whereas when you are self funded, your funding claims and if there is a surplus or if you perform better than expected, that builds that reserve fund. And I think, you know, one thing we talked about before is historically, you know, the the county's loss ratio has been north of a 100%. I think every year the last, you know, the ten years that I've I've working on the account, and that's always the concern there is right now getting a little bit of a a haircut or the the carriers are taking a haircut to ensure your population.

Except what would that look like if you took out the admin expenses that they're that they're charging versus what we would pay for self funding? Because, I mean, they are they are picking you know, they are getting paid, and that's part of that that loss.

Well, you also

So the loss ratio that Nate was referring to is just the claims. So they are paying out more in claims than they're receiving in total premium. So that's not even accounting for their admin. So if you add in their administrative costs as well, they'd be losing additional money to what they're to what they're saying as well.

I thought the admin costs would list the

Not in the medical loss ratio. Right. That's that's why we usually see loss ratio as targeted in that 88 to 92, 94% space so that if they're if they're running on target, they have a, you know, a five to 8% cushion for Sure. Their admin fee as well as their opportunity for profit. What I I think what we're alluding to and the reason why, I mean, whatever would ever insure a group and take a loss is the insurance companies have their relationships with the wider systems Oh, yeah. Where there is some level of they want the bodies in the door. Correct. I see Scott's got his hand up.

Well, thank you. Maybe you just answered the question I was gonna ask. But, you know, if year after year, we are running so high, why does Dean continue to do business with us, or is there some other element that we're not understanding that makes it acceptable to them?

What I would say and, Brian, please jump in here. As we think of there's the different insurance models in the fully insured space. There's the PPO carriers, UnitedHealthcare and Anthem we talked about, that generally don't own the doctors or own the the systems there. You see much higher renewals because they don't have the alternate source or other way to kind of make up for losses on the insurance side. Whereas when you have provider owned HMOs, the insurance, they don't it's not good for it to run-in the red. So we want it to be a profitable piece, but there are times where they're able to make other decisions based on we want the bodies in the clinic. We want the cache of being able to ensure this population. Mhmm.

Okay. So there is a trade off. It's not just simply we're running at a 116%, and that's that's not quite as bad as it may sound. There's there's trade offs on the other side.

Correct. Correct. I completely agree with what Nate said. I think feeling of to make sure that their hospitals and clinics are full is huge. The ability to say that we insure Dane County is massive. You are such a staple of the community that the ability for them to say that allows them to sell to other smaller groups that are like, Dean County trusts them. I can trust them too, that sort of thing. So both of those cannot be understated. If you were to go to UW Health from Dean, that would be a massive population loss for their doctors for what they're seeing, and that would have cascading effects to what clinics they can have open in all of those different things.

Because there's the high fixed costs associated with the clinics in those pieces. But that is also but but that's a key point of why we have not been keen on self funding for the county is that we've been able to get carriers to take, you know, the population that's running at a higher loss ratio and continue to give us renewals that are less than, like, pure calculation would say they need in order to have you be a profitable account.

Right. Yeah. When Dean had the county had been with Dean for a long know, forever and ever, then it was p plus came in, I think, in o four. And then in 07/2008, we moved to solely to physicians plus. So Dean kinda took a step back for ten years and we moved back to Dean in 2017. We would have done a couple, yeah, two RPs probably in that time and Dean had submitted. But it's just what they said is exactly right. You've got the two pronged approach, but also any carrier will be happy to say, yes, we insure Dane County, and that's going to help them continue to grow as well.

The one thing I had asked you both when we were kind of getting this set up, and I will ask it again because I imagine other people might have a similar question. When we think about self funding, is there a possibility of partially self funding? So self funding the existing POS, for example, or just self funding the pharmacy.

Yeah. No. You because and and, Brian, please. But, you know, with with Dean or filling the carrier, you're gonna wanna have you know, they use Navitas as a pharmacy benefit manager. You know? If you were to self fund the prescription drugs, you know, then all of sudden, you have two very different things going on. And especially with, prescription drugs, you're not gonna be able to have everything together under one umbrella. I think I'm saying that right?

I would, yeah, I would agree. There are very special circumstances, but I don't think it would the integration is very clunky, especially with Dean if you're not using Navitas. So it would be definitely member impact if we wanted to explore that if they were to even allow us to have that that option.

I guess I would add to that is because sometimes we'll see situations where you have you know, there's different we used HMO and POS here. The third kind of broad type coverage is PPO, which is generally what we see for folks outside the HMO service area. So if we only have population of folks up in Green Bay that were on on the county plan or were in California, they would be taking the PPO network, and that is a very different administration piece. There are times where we will see, like, m three had this arrangement for our population where we were fully insured in Madison with ports. But for our, you know, Green Bay, Wausau, Milwaukee populations, we self funded those, with with UnitedHealthcare, but that was a there's not overlap.

So the HMO to POS is not something I would expect an insurance carrier to allow nor would you want that. Yeah.

The the they wouldn't allow the choice is typically what that would be. It'd be you would have to choose if we'd stay with Dean Dean or your self funded population, and And where you would draw that line would be very difficult to say To do both. To do both. Yeah. You can't you can't say

No.

Given everybody's roughly in this area, as needs that. Like, you can't draw an imaginary line for people west of this line are taking the PPO. So you you wouldn't do it based on network

in terms of, like, in that overlapping population. Yes. Specifically, if you're if you're self funding the POS plan, you basically be taking on all the bad risk. Yes. General, PVO is more expensive. Folks that are in the PVO POS. Yeah. Sorry. Our the POS are are doing that because they have a relationship with a doctor or they want access to specialty care or else. Yeah.

K. This next slide, I think, is an important distinction because it's really easy to think of self funding kind of as a a monolith. In some ways while we're fully insured or self funded. This is getting into inside self funding, and we think back to the screen where there's this little transfer risk continuum. The ASO versus TPA piece is kind of a similar continuum, but for how you're structuring the program.

An ASO approach is where you're contracting with with a carrier to allow you to self fund, but they're still making most of the decisions for you. So you're going with them and you're you might be buying stop loss, but they're they're they're necessarily there. They're picking the network, everything else. You're just getting kind of the risk reward side of the claims. Whereas the TPA approach is truly unbundled. You are making all of the choices. You're, like, carving out stop loss. You're carving out the pharmacy. You might be adding different networks. And so, like, examples of this is even within, like, the same organization.

So UnitedHealthcare has their self funded ASO arm, which is UHC self funding. When we do a funding forecast for them, it's giving us a single admin fee that encompasses everything versus the DPA arm of UnitedHealthcare is UMR where they're giving you a, you know, an Excel sheet with a giant list of of costs for each program where you're saying we want to we want to buy the nurse line. We want to buy Teladoc, and you're making individual decisions all the way down. Brian, is there a better way to say that? Or No.

I think that's perfect. I think if you think about it, we were talking about purchasing those different partners, StopLaw or StopLaw's TPA network PBM. That's that third party administrator route, whereas the ASO is gonna be about it very similar to what you have with Dean. You'd be choosing UHC. You would be choosing Dean. You're gonna get everything that comes with it. You'll have a little bit more flexibility from a plan design standpoint, but you're gonna be using all of their partners. You're gonna be using all their systems. So it's a little less choice and more structured than what the third party administrator is. Some groups like that.

Some groups don't. Typically, to see the additional savings, the different solutions that you can try and put in there to curb some of those costs, you're gonna need to go to the third party route. Not always, but that flexibility of the third party route is what most groups are looking for when they make that transition.

How long are the contracts usually for for the stop loss insurance, the third party administrator, or the network?

Stop loss is gonna be a yearly contract, so twelve months. Third party administrator, you can have some guaranteed contracts for three years, but, typically, those are one year you sign one year contracts. They might give you a guaranteed for rate for three years, and then those have a nominal increase after that, typically around 30¢ per employee per month. So that average increases after that. They renegotiate network contracts and PPM contracts on a yearly basis and even throughout the year depending on what's going on, new drugs that are coming out.

But, typically, you don't sign multiple year contracts for those. So they're continuously improving their negotiations with the providers and with the drug systems to keep that as competitive as possible.

For new groups making a jump from fully insured, do do we see them take an ASO approach versus the TPA, or is it really depending on the group and the risk tolerance?

And Depending on the group in the area and how much they wanna be involved in the plan. Like I said, that ASO is gonna be very much more bundled, take what you get type of situation. In the Madison area, those groups that we are seeing moving to self funding are moving that third party administrator route. So it does give them a little bit more flexibility to do different things within the area that we're seeing. There's different cost mechanisms that we can look at and different providers that we can look at when you're working on that third party administrator, and that's lot of what the groups in Madison are trying to get out of it.

So that flexibility in the Madison area is what most groups are looking for from a third party administrator.

Only to add is, like, courts just is is in the process of rolling out kind of expanded and new ASO approach and partnership with health partners. Obviously, they were in our office and kind of agent their agent education day not too long ago and walked us through value proposition there. We asked them point blank. We could use this before with the best option is to get groups that are Dane County dominant aren't gonna be the best fit for this because the discounts are still going to be better. Quartz is fully insured.

What they term what UW Health is charging them on the fully insured side than what VW Health is charging courts on the self funded side. So medical discounts are pretty much always going to be better with the provider owned HMO. You're going to get with even the provider owned ASO. And we do this at the top where we're defining stop loss. There are two different types of stop loss that are purchased.

There is a specific or individual limit, which is, you know, the amount of liability the plan is on the book for for each individual belly button, and that's something that we can with or without aggregate coverage, and the aggregate is looking at overall risks to the plan. And so it's kind of a cap on total expenses. Carriers will not write ag without spec coverage, but we're kind of when you're thinking about these specific is that catastrophic claim that's at list of high cost claimants that is just, you know, really eye popping dollar amounts for certain people. The aggregate is saying, you know, we expect your overall claims cost to be 70,000,000. We're gonna put an aggregate limit at a 125% of that.

And so if you instead of having lots of high cost members, if you just had lots and lots of members that has that had significant costs and overall, the plan ran hotter. Brian's better with seeing that. Ingregate sleep

at night insurance, it gives you a maximum that you can you know what that maximum is that you're gonna be able to spend, or I guess that you would have to spend. It's that sleep at night insurance.

That's what I said. And then we talked about lasers where you are modifying the specific or individual deductible on an individual member. Those do generally last for life. When when that's put in, it's something that typically when we're writing stop loss contracts or working with carriers, we're starting with a no new laser contract with a with a maximum increase percentage built in there. Saying we're buying only laser with a 40% max rate increase.

So worst case scenario, perform really badly, the insurance company can raise your stop loss rates by 40%. Now in that circumstance, we will often look at the look at laser options as an alternative to say, well, we think that these two members are gonna drop off the plan. I mean, tweak that funding and it comes out its forecast lower.

40% sounds very intimidating.

It is. It's on the stop loss premiums. Right. But no. And that's Sounds intimidating. Very much so.

Yeah. It so the better way I could say that is there's a yes. It it sounds very intimidating, but it is a small portion

of the overall cost. Okay.

So it's gonna be I mean, estimates for group your size, you're gonna be paying $1,500,000 in stop loss premiums, so 40% is

is that

Sounds like a lot to me.

It's a lot. No. It is. It's not a 40% on the overall premium. Okay. Because claims are a much larger portion of the overall cost than stop losses.

Okay.

And so Dean today or any fully insured carrier is also gonna have their reinsurance. So when we see the claims, you know, when they say the pooling point is x, you know, any claims that are are over that amount, then Dean filling the carrier name will have their reinsurance premium. So part of your that FIS premium you're paying, a portion of that is Dane County's, contribution toward that reinsurance premium that Dean has to pay.

Thank you.

I mean, it it is scary, though, because that is also of the different, you know, kind of costs that make up the the self funded plan. That's the one that you have more ability to to play with and modify. Is the claims costs to some extent are the claims costs. You can put in programs and try and address those, but the math is still there. So I don't if I better way to say that too.

That that's exactly your claims are gonna be there. That's that's with programming with population health, all those different things. The claims is what you try and adjust for a majority of your costs. Those large claims are gonna happen regardless of what you do on some of those. So that's where you try and limit that exposure as best as you can while trying to decrease the costs of your everyday MRIs and doctor visits and everything like that.

Right. I mean, we can only do so much when we're kind of living in a society where it's the hospital costs are what's skyrocketing. So we can

Into our conversation, transparency is still really hard to come by. There's just not the opportunity to truly know what things cost well in advance about having all the codes and people get the codes until procedure happens. This slide is is trying to kind of position the stop loss protection for the specific as well as the aggregate coverage. So on top left, you got that. There's the green lines that are showing employer risk and then how much stop loss could be on the hook for for an individual claim.

Same thing on the right for aggregate, you have improved claims, and there's your protection potentially for a portion of that at an employer risk account. This is getting into some more examples of how specific stop loss works with different claims. So the example here is a $75,000 deductible, and you're looking at three members that the employer paid out a total of $200,000 on them. And you see how this breaks down. Employee number one had $300,000 in claims, so the stop loss carrier is taking $225,000 of that.

Employers at 75, actually, it's a 150. It's split evenly at 75 each. And then, and the third employee, they only had $50,000 in claims, so none of that went to the specific deductible and stop loss carrier. As Brian alluded to with aggregate stop loss coverage, you know, this is the overall risk to the plan. Typically, quarter is around 25%.

It really is a sleep at night insurance for Chuck to make sure that, you know, something something is horrible happens that there's, you know, some level of stop. These next couple of slides really get into the kind of some of the nitty gritties of stop loss contracting. I don't think this is probably appropriate space to look at that. And what this is alluding to is when you're purchasing a stop loss contract, you're you need to think about what happens next and what happens after that twelve months is done. And so making sure that your contract does not allow a gap is really important.

That's where we come in, and making sure that there's, you know, time for run out because when you're fully insured, if you leave if you left Dean and went to courts, it's a clean break. Yep. Any claims that were part of Dean, keep going Dean. They pay them. You don't have to worry about it.

When you are self funded, if you decide to go fully insured or dissolve the plan or make any sort of changes there, you are still on the hook for claims that are incurred but not yet paid. And the stop loss contract dictates how those are handled. Imagine so you end up in those just perfect storms of, you know, perfect claim hits the last day of the plan year. It doesn't get paid for for a couple of months as it's work as as it's working through all the stages of review, you don't wanna end up in a spot. Certainly, we don't wanna end up in a spot where

you just go back to

our clients and say, hey. Hey. If a billion dollar claim isn't going to stop loss, you're you're on the hook for it. And there's other considerations too when you're purchasing, like, TLO insurance or, you know, kind of how you're handling the run out. And, again, that goes into risk tolerance. You

know, I think that's exactly it. I think this is something that we'll cover if and when we get there on how do we wanna structure this, but it is our job to make sure that there is no gap in coverage regardless of which way you go.

There's a

couple different ways we can ensure no gaps in coverage, and we can talk about the pros and cons of both of those. But it's our job to make sure that we choose one of those two options so that there is no gap and there is no liability for accounting.

And, yeah, you pay more to have the better contract. And this slide is just kind of, you know, showing really tiny tracks, some of the the great work products that Brian's team puts together. So we have our health plan performance monitor, which is a kind of a monthly snapshot that's gonna show, hey. What's the loss ratio running at? We're gonna break it down into the the key components of medical, pharmacy, fixed costs.

We're gonna show you stop loss reimbursements today, show the different pieces. That's something that would go to, you know, general administration. We probably if we went this route, you'd probably see some of that stuff at IAC meetings of, hey. Here's how the plan is running so far. It's not a perfect prediction of here's what's gonna cost in the future, but it is the here's where we're at today and get a pretty good idea of, alright.

Well, we're running north of a 100%. Probably not gonna be a great renewal in terms of what's gonna come out. And that leads into the right hand side is the funding forecast, which is where Brian's team, you know, puts together, you know, when maybe start the sample and go to a full on proposal kind of breaking down claims for for two year for two years, trending that stuff forward, here's here's what it costs, here's what we think it's gonna cost, adding in the fixed costs, and then our recommended funding rates. So So we're saying we think you should you should fund it to this level in order to match the risk. And then ultimately, employer gets the the choice to say, you know, we were comfortable with those numbers.

We want to go up or down. So it's a it's a very different renewal conversation in the self funded world than fully insured. We're fully insured. We're negotiating with the carriers. We're looking have a little more information than we do. We're kinda going back and forth. Self funded, you get to pick, but, ultimately, you have to live with your decision. Yeah. So it it's there's not an argument of, well, we're maybe changing the deductible and, you know, actually, you say, we think it's gonna be this change in deductible is gonna generate 2% in credit. You might say, no. No. No. It's gonna generate 2.5. We can do that. But, I mean, there's risk pieces there.

So that's a whole lot of information.

No. That's helpful. I appreciate you putting it together. One question I know we talked about last time was m three's commission when we're dealing with a place like Dean. How does m three's commission work with self funding?

So with self funding, what we do is when we quote your stop loss, we'll quote it what's called net of commissions. No commissions. It used to be back in the day, and, again, correct me if I'm wrong, where stop loss carriers would build in a 15% commission. That'd be split between the third party administrator and then the agents or the broker. Well, then all of sudden, over time, the carriers started putting in an additional two or 3%. We're like, well, that's not fair to our clients. Or if you guys have a bad year, we don't wanna gain off that. So we'll get the net of commissions, and then we do generally, we'll do a standard, 10% flat 10% of the stop loss premiums, and then that's built into your funding forecast.

So you gotta you gotta do a percentage stop loss or kind of the direction we're seeing it go more commonly now is a flat per per month charge. You're saying we're gonna get this much per member. And that's something we would have on the funding for that, so we'll be transparent there. That's where we go into. There's, you know, there's a certain baseline of of cost to do all the administration and Brian's team run numbers and do some of those things. But at a certain point, we're meeting that sort of like the PPM is is a more fair way than the old school Yeah. Percentage of stop loss goes to Shannon's point. Stop loss goes up by 40%. Yes. We had to do a bunch of work to try and buy that down, but that's not a super it's not a super good message or well aligned in subjects. Okay.

What other questions do folks have?

There, you know, are there gonna be questions, any tweaks you wanna see to this presentation before we do it again tomorrow? Make it more clear, you know, suggestions there.

Any thoughts from anyone? Feedback for tomorrow?

I mean, I think I understand it so much better now.

Yeah.

Well, I think it is helpful, you know, because I think many of us probably didn't realize kind of how many different components there were. Okay. So that's helpful to understand. Yeah. So I'm sure the group tomorrow will have a host of different questions among and maybe if I mean, some of the ones that we asked today, if they could just be integrated. Otherwise, if they're not, we could reask them. And

And also our approach of kinda, you know, keeping it high level made sense. I know we we we covered a lot of information, but there's a lot to it.

No. I think it's helpful. And then do you know for, like, Rock County, I think, is an example. They are then I think they work with the Alliance as I recall. Do you know who their third party administrator is?

I do not. I think at one point, m three, somebody in m three may have worked with them. But, yeah, I I don't know at this point.

Just to help illustrate Yeah. You know, how this all fits together. Yep. And then going back to the lasers, would it be most likely that if Dane County were to pursue this, Dane County would be trying to pursue a contract that did not have lasers?

That's our approach we'll always look at. But, you know, out of the gates, you know, some carriers, Southwest carriers could come and say, well, based on these, we're gonna give you multiple lasers or one or two, but then be a no new laser contract moving forward. So it's yes and no. I mean, really depends because each carrier is going look at the claims data. And we've had carriers, Brian can speak more of this, where we we we'd expect a laser on this individual. And two carriers don't give it, but one does. You're like, okay. Because every carrier is gonna have their own their own risk tolerance too. They'll look at, k. This claim has been going on for a long time. It's a $1,000,000 claim. They're maybe on the the back end of it now. So we as the stop loss carrier fuels, we don't want to put a laser on there. That sound right?

That's exactly. And I think the level of risk that Dane County would take on on a per member basis would also dictate where those lasers might be set. If you are setting it at a much higher level, just throwing out random numbers here, like $500,000 versus a $150,000, they're gonna be much more likely to place something on that $1.50 than 500 because you're already taking on that much more risk. So it depends on where the county would decide to set that specific as to what the stop loss carrier might wanna put on there as a laser. So there's a lot of competing arguments for whether to include one or not, but we are we do our best to not have any because that is just easier to administer and to think about and also easier for renewal's sake and just running the plan.

It's a kind of a terrible term as well. I mean, it doesn't say it sound really.

Yeah. No.

It sounds like it's trying to

It's actuarial term, probably. Yeah.

I don't

think we could work on

that. Okay.

And who are the big kind of players in the in Dane County that are currently self funding?

As far as employers? Yes. Oh, gosh. I mean, there's a number of them, self funding. Let's see. Well, the the state's the biggest one. You know, they're self funded in and of their own, the employee trust fund. State's not funded. Or not self funded. Sorry. No. No. The state is not. No. So Nate and I, so we have one, two, three clients we work with, one in Milwaukee, two here that are self funded, you know, because and they also have employees scattered throughout the country as well.

Are these private businesses?

Private businesses. Yep. Yep. No. The ones Nate and I work with are all private businesses.

I guess, Brian, do you the thing within you the groups, do you see a lot more clients, like, within the public sector? How frequently do you see self funding?

In this area, we're seeing it much more self funding public sector outside of South Central Wisconsin, outside of the HMO stronghold. But inside, because of the concentration of employees typically within schools, within municipalities, because they're all concentrated here, those HMOs make a lot of sense. Yeah. Typically, in the Madison area, when you are looking at self funding, you are gonna have a rather extensive population outside of Dane County, outside of the Southern half of Wisconsin that it starts to make sense to go self funding. We're talking typically at least 25% of the population, if not closer to 50%, is outside of I'll just call it Wisconsin, but call it Southern Wisconsin Yeah.

Is where we see a lot of those Madison based companies being self funded from a private sector.

Travis, you might have a question.

I guess I have two questions. Am I allowed to ask questions? Am technically with the peanut gallery today, so I didn't Travis

is here as a member of the public and also a member of IAC. So we'd be happy to hear your question, Travis.

I was just curious, of the self funders in Wisconsin. Are there any that are comparable to the size of the of Dane County as far as how many people would need to be covered? It's a mix. You know, we have as Brian said, there are some employers that are as little as 75 employees. You know, a lot are between, say, a thousand and two or 3,000.

Yeah. So there so, yes, there are some public entities that are roughly the size that are self funded in the state.

So would you liken the, self funding more to the level of expense as the point of service plans are because you don't have those contracts with providers? I mean, do you I mean, overall, as far as expenses go, is that's what is that what's being charged back to the the self funder is more of the full cost of the claim rather than the negotiated cost?

I would say it's gonna be pretty close to what Dean has priced out. I don't have the exact price difference here. It's not gonna be that much. Sorry. I have it pulled up here. The full rate between the h one POS isn't it's not gonna

be that high of a

difference, in what your overall cost would be to move from fully insured to self funding.

Okay.

It's gonna be depending on everything. We're talking probably 10 to 15% increase on your deemed claims to what we're seeing in cost.

Because of those negotiated rates. Okay. Thank you.

Did you have a second question? Okay. Thank you. Alright. We have about five more minutes. Did anyone have any other questions or feedback or suggestions for tomorrow?

Thank you.

Alright. Well, thank you all for doing this. We really appreciate it. I think it was really helpful for us, and we'll look forward to further discussion tomorrow. I know. Sorry. Can we get a motion to adjourn at this point? So moved. Shannon? Second. Second. Brian? All in favor? Aye. Away we go. Thank you very much, everyone.

Thank you.