City Council - Special Meeting

Slow down. There you go. How about those Chiefs, huh? That first play, I knew we were doomed. Here's Jeff. I'm glad I was supposed to be up there. I'm glad I didn't go. Hey, Jeff. Ready? All right. Here we go. Special meeting of Washington, Missouri City Council, Monday, December 8th, 2025, 5:30 p.m. Fair here. Briggs. Foulter here. Hydrri here. Holm here. Kne here. Capsel here.

Sentrop please rise for the pledge of allegiance. I pledge allegiance to the flag of the United States of America and to the republic for which it stands. One nation under God. Indivisible with liberty and justice for all. Approval and adjustment of agenda. Motion to approve. Second. Motion by bear. Second by coulter to approve. All those in favor say I. I. Motion passes.

Report of department heads health benefits renewal for insurance. Good evening mayor and council. Uh thank you for meeting with us this evening to have this special meeting concerning health insurance renewal. Uh as you have before you our letter from the HR department for myself and attached to that are some of the rates that we will be uh rolling out to employees. If you approve our recommendation tonight, I'd like to bring Scott Shreper up to tell you about what he and his team have presented as the best path forward and the recommendations and then he can ask or answer any questions that you have at that time as well. We also have Tammy here for financial questions uh that Darren and I or Scott cannot answer.

Thanks Sean. Thanks for coming out tonight. Um let's uh let's start with the ancillary is pretty easy. Um our ancillary insurance is like our dental, our vision, our life, uh work site, benefits, accident, health, uh hospital indemnity. We received an 18% increase on our dental. We're running about 124%. Um it was expected. Uh no other carriers were any lower than that. And the rest of those benefits we have a a zero uh increase on rate pass. So that's uh pretty simple. We're able to stay with all the same carriers that we have now. So that's the ancillary. The medical was a little more difficult. Um, not the negative eight we got last year, uh, which was an easy decision. Um, we had, uh, 22% increase from United. We had no other carriers that bid us. They all declined to bid us because our loss ratio there is about 120%. And we've got four claimments that are are pretty hot. Uh they're going to end up well north of uh six figures. And so that was what was scaring our other carriers away. So Anthem, Etna, Sigma, all declined. And if you remember last two years, I've been talking a little bit about self insurance. Um, to be able to do that, you have to have two protections. One, you cannot have claims be lasered out, which means we put a reinsurance figure on there for the city. We can't pay any more than 100,000 for any one claimant,

one member. a laser would be for somebody for a carrier to be able to come in and say, "Okay, everybody else is 100,000, but Scott's, you know, we know his is going to run 400,000, so we're going to raise that up to 400,000." So, you lose that protection. And the other cap you have to have is on the reinsurance part that ensures that it's only going to be 100,000 because you don't have it on both sides. They can say, "Okay, we're going to raise your reinsurance by 300,000." So then you're getting caught on the back end. So we've got caps on both of that. And what that does is a couple things. You know, you look at you say, "Okay, if we can do 22% fully insured and 22% self-insured, why would we take that risk?" Well, for the first reason, being able to cap everything at 100,000 when we know we're going to have probably that should save us probably two maybe as much as $400,000 on those four claims. I think it'll save us about 200,000. The other thing that we have is we ran all of our prescriptions um through our top 25 only actually. And on those top 25 prescriptions alone, we'll save $200,000. and by resourcing those and then by actually getting the rebates back from the pharmaceutical companies which United Healthcare and all the carriers get now. So the city will actually get those now. So an example um Zeralto, it's a a hard drug. It's um $1,000 a month. Well, guess what? You can go to Costco and get it for zero cost.

How do they do that? It's because Costco is getting $500 back in rebates from Fizer or Merc or whoever's manufacturing that drug. You don't even have to be a member at Costco. You can walk in and get that done. So, our pharmacy benefit manager, Smith RX, that we'll use will automatically source that for our employees. So, we'll we'll save that. We'll save those dollars. You know, it's just like you hear, oh, good RX, Mark Cuban's cost plus, they'll source that out for us automatically. We won't have to do anything. Shauna won't have to do anything in the the HR side of it. So, there's no HIPPA, no violations or anything. So, looking at the, you know, 200,000 that I think for sure we'll save on the medical side, maybe as much as 400. and then looking at saving, you know, 200,000 for sure just on our top 25 scripts, not even taking into account the rest of it. I think we'll we'll take that 22% and I think we have a chance to get it maybe all the way down to a pass because we'll save that much money. So, uh, if you look at the rates, what we, after, uh, sitting down with Darren and Shauna and Tammy, I think what our recommendation should be is to keep our rates at that 22% and run it just like we would have taken a fully insured renewal and then we will bank those dollars and our next renewal, we'll have those banked and then we can offset anything we have. But if we run the way we think we will, I think we'll be flat. Um the upside risk on this is if we if we run at 120% of which is what

we're running at right now, like I said, I think we'll take 400,000 off of that or about 20% anyway. Um we're going to come out the same. If we would run worse than that, it could cost us 400,000 more. And but I think our risk there is very low because we've got those caps. So I think we have a less than 1% chance to run worse than that. And that's, you know, just 40 years of experience in running these type of programs. So questions. I know I threw a lot at you guys. So when you're talking about a cap, are we talking about like a stop-loss cap?

And when you said laser, that kind of triggered my ears too. So is it two forms? Is there an aggregate stop-loss for the group and then another one for single? Correct. Okay.

Correct. So the aggregate stoploss means the group as a whole if it runs very poorly, everybody would have to be sick and nobody get to that 100,000. Well, the city, you know, for the last 20 years, we've always had three or four claims and we've had hard years that have been 250, 350, $400,000. Those are where we've, you know, had our bad renewals and had to make a switch. This protects us from that. And we know we've got four sitting out there that could be bad, but we've already got no lasers guaranteed to us on the program that we have. So that that will save us it'll take our 120% loss ratio and drop that down. That's going to drop us, you know, probably 12% or so right there. And then another 200 grand and that we know we'll get for sure on the pharmacy is going to drop us another 12. So that gets us where I think we're going to run flat and why it's worth making that jump and doing that. So give you another quick stat. Um pharmacy right now accounts for about 34% of the spend in all the plans across the US. In five years that's going to be up to 43%. And because cost of drugs are going to rise that fast, okay? Same drug you taking now, guess what? It's going to be more expensive. And getting those rebates back, if we can recoup 30 40% of those that cost, you know, just do the simple math at 40%, you're getting 40% of it back, you're saving 16% of your overall cost. So that's where the market's going. And

to get rebates, so you have to be self-insured. But you can't do that without the protection of no new lasers and rate capping your reinsurance, both aggregate and individual. That's where that's where you see people that's where you see companies and municipalities and public entities make mistakes. you know that's they don't have caps, they don't have guarantees and those are lifetime guarantees not a year, not two years, not three years. Okay.

I know last meeting we talked a little bit about administration of it and I mean are we intending to take that I guess that might be a Shauna question but are we intending to take that on here third party?

Uh we're we're going to use that's the other thing too is we'll use United Healthc Care's third party administrator. It's called UMR. So the employees will have a easy transition. They're going to use the same network they're using right now. In fact, right now they have a choice of two United Healthcare networks. One without Barnes Jewish Christian providers and one with now everybody will get the Barnes Jewish Christian network. I mean if you look on here the buy up right now the people that are buying up their rates are actually going to go down. And so they'll administer that. We have what we call an HRA right now, a health reimbursement account that we buy our deductibles down with. We'll keep that same account and we'll just fund more money in it because we're s we'll take the premiums that we were spending, put it in that account, and that's what we'll pay our claims. And they'll they'll draw that out of there every week just like they do our H right now.

So there's nothing extra there that goes to UMR for administration. Yeah. Yeah. We'll we'll pay an administrative fee, but that's included in that's included in our cost. Yeah. All of our administrative fees, our reinsurance cost, our stop loss, and everything is all included in this cost as are our anticipated claims. Scott, have you ever had to compete with uh self-insured? We write selfinsured all the time. I've probably got 70, 80 clients that are selfinsured. What What's the amount they'd have to side to have a self-insured.

So when you we have what's called a lag. Your first three months coming in. Your first all you're going to have your first month is basically pharmacy claims because it's a retail transaction. Everything else is going to take 30 to 45 days, some of them 60 to 75 days to process. So first month you figure you're going to run, you know, maybe 30% of what your claims would be. Next month you're probably going to run 60%. Next month you're probably going to run 90 to 100%. And then fourth month on you're going to be what they call mature. So we have our clients acrew that money for those first three months that they're saving. acrew that money, set it back because if you ever go back to fully insured, guess what? You know th you'll have what we call run out. So those last three months, you'll have to pay those out and you'll have that money acred because you didn't spend it from those first three months. So coming in your your cost actually be much less the first three months than it would be. But I I tell people don't spend that acrew it because if you ever get out you'll need that as a run out because you're that way you won't be paying fully insured premiums plus the claims from your self-insured. So and the city is in fantastic financial position too. I mean you guys have done a great job been great stewards you know and sitting and talking with with Tammy it's it's phenomenal what you guys have done. So, but yeah, so that's needing a pot of money to start with. You don't need that.

So, if you were a if you didn't have the financial wherewithal that you guys have, I might say, "Hey, you know what? You know, account for a little more upfront, but it should be very smooth going in. You should actually have excess Scott, correct me if I'm wrong, but uh from 25 to 26, a family will pay more right around $1,000 more a year deductible. Is that true? Not not deductible. In deductions, payroll deductions,

right? Okay. So, I misspoke, but they'll it'll cost them $1,000 a month or a year more, right, for for family coverage. Okay. That it will. And again, they they had an 8% decrease last year. And if you look over the last, you know, 20 years, I probably should have brought a chart. I bring that every now and then. Uh be helpful. Yeah. Yeah. It's the increases they've had have minimal.

Yeah. It's been next to nothing. And the other good thing about it is you guys, I mean, we've got over 500 clients and nobody has a zero deductible 100% plan. The other nice thing for the employees right now get this and they look at they say, "Oh, that that can't be." And they want to try to charge them even though they know the H is going to pay. Now they won't have that issue anymore because it's a a straight zero deductible. There's no HR that's going to pay and process after the claim initial claim processes. So the administratively uh user experience it's going to be better for them.

Yeah, that the family is going to pay a little more if they if they were buying up to the network that has BJC in it. right now their premiums are actually going down. Darren, does the city pay any portion of city employees uh health insurance? Yes. 70% per pay period for for employee only. The city pays all but they pay all50. But those other tiers that you have the other tiers

we pay all. So if even if you're family coverage, the city still pays all except $50.50 50 cents for your coverage and then the employee and city share the cost of adding your dependence. The city still pays 70% of the dependent premium and the employee pays 30% of their dependence premium. I did forward you just now um what Scott had sent that's the comparison what he's talking about the United Healthcare versus the renewal versus the self insurance and what that plan looks like side by side and I just found the um rate history I'm going to forward that as well. We did we did uh uh budget for a 10% increase this year. I mean we look back the last two years and I think it was eight% 9%. Prior to that I think we had five good very good years where you I mean we were hovering right around 0% increase but then then u we had eight I think at a nine. I'd have to look exactly but uh we budgeted for 10. So, it was just a matter of coming up with the additional 10%. And Tammy, we were talking about it today. I mean, we we've been doing very well with savings on the general fund at the end of the year. So, we that's why there's no budget amendment. We don't need to do that. We can go ahead and monitor it and track it throughout the year and we're going to be able to see it firsthand.

I mean, obviously, our hope would be the savings side would potentially cover that. Yeah, absolutely. Yeah. Well, you hope the savings cover it, but you also hope that we're not at 120 loss ratio, but we're at an even loss ratio. And then we're at 100. We're money ahead, right? At money ahead. Then you still now you basically become your own broker for pharmaceuticals. Correct. I mean, that's I think it the self-insured. I was scared when I read the email today just part because I'd just like have been shy away from that forever. Um, but after hearing the explanation, it kind of makes sense. And I guess you could simply say that United Healthcare has been making money on pharmaceuticals for so long, you're taking, we're now experiencing that

um cut. So um I guess my question is on the on the 100,000 cap. If someone does have a catastrophic, we have four now. Do we just stop paying for theirs and they're responsible? That's another insurance that we have on top of it. So the reinsurance picks up and pays off. And so it's no longer the city's responsibility. Nothing over that 100 goes to a reinsurance company that we're paying premiums for. That's part of I was talking about with the individual loss is is the key here. So, you know, at some point we get to go uncle, you know, we're out at 100,000 we get to go uncle. Correct. We're out. Correct. And you're individually, but also if all of us Yeah. Right.

150 or we go to 300 and you're only at 50, but that puts us over an aggregate. There's also that. Gotcha. Okay.

And Jeff, you're spot on with the United Healthcare. So, all these carriers, I always say it's a conflict in interest because United Healthcare, they own their own pharmacy benefit manager, which is Anthem owns their own, which is Carolon. Etna is actually owned by CVS and Sigma owns Express Scripts. So where the ACA law requires them to only make 5% or less, there's no law uh in limit on their pharmacy. So that's why they they have separate these pharmacy benefit managers that they all own. They're making 18 to 22% a year while their their medical is is making, you know, under five.

And by this, we can take advantage of that and have our own savings.

Yeah. It's it's just a matter of time before it, you know, it comes. It's it's what's coming across the whole industry. It's just being large enough to do it, which you guys are. You know, five years ago, I'd say if you weren't 250 employees, you shouldn't consider selfunding. But that continues to come down. I mean, there's companies out there I think are too doing it. But you know there's companies in good financial condition between 50 and 100 is doable now because you can set that stop loss at 20,000 or 25,000 and get it to a manageable number farm.

Are you privy to what Franklin County is doing on their self insurance? I know it's with a competitor but as I am that's uh so I can give you a little history on that. I I just at first I think they were reluctant too and they wanted to do it but then they they went from I'm fortunate because my wife has that and it hasn't been it's an HR nightmare there but the employee has not been bad. So that was my discussion at home for the last for 10 minutes. That's why it's not bad. So

they they when they went in uh they did not have no laser protection. Uh they received lasers. Um the fully insured bid they had that year was 2.3 million. I think they spent 5 million their first year because they had no lasers. They spent five million. Cost them five. Yeah. So uh yeah, the fear you were talking about. That's the fear. That's why I was asking about I I agree. That's why I brought it up because I know that that's I didn't know the number was that high, but I knew it was a problem.

Yeah. Yeah. and they they went in and now now they're in no man's land because they can't get out because they've they've got lasers they can't get rid of. Uh I believe Edwardsville is in a similar position. Uh have been for 15 20 years. Um you can't not have protection, right? You know, same way, you know, we do a ton of school districts that are are self-insured as well and they've operated fantastic, but you you have to have those two protections. If you don't, you have exposure, right?

And as a public entity, you cannot take exposure because it's not like you can go out and say, "Oh, we're going to sell more widgets and bring in more revenue." Your revenue is is capped and and not always a certainty because you don't know what other governments and other programs are going to do. So then my only other question was in an email we said something about programs for employees to I guess it was look not use the insurance right I mean or not have so many claims or what how do you I mean but there's no way to tell somebody not to but do we have an idea I thought it was something to do with that am I wrong so a wellness program we have a wellness program we've had that in place for quite a while

and that will continue with this that will continue with this yes you if you look on that second page of this handout Yep. that you got. If you look at the 20 26, which is the the second table down, the top one is the base plan and on the on the top right is the buyup plan. And that's what Scott's telling you that those people that are in the buyout plan are actually going to see a decrease. Now, we have about 25% of our employees are in the buyup plan. 28 about 28%. 28 employees. All right. out of 130% 122. There you go. 5%. There you go. Real close. Yeah, I was pretty close. I'm not gonna call you a liar over that people.

Anyway, so you have those those folks are going to see a reduction, but what you see on the second one, you see that potential wellness rebate per pay period. That's where they get that. So, that's still in place. We're not going to we're not going to do away with that. So, if they don't have a claim in a month's time, they get $25 back. No, no, no. They have just they don't have to they don't have to pay if they don't go get a wellness check and a single employee is going to pay just for example, I'm just going to use employee only. They're going to pay 2525 a month.

If they go and get their wellness check once a year $50 a month, right? 50 bucks a month. 25 per pay period. Thank you. And so I that's if if but if they go once a year to go get their wellness check, well then you get that back. Then you pay 50 cents a month every pay period. So once a year we ask all employees to go get a wellness exam with their provider of choice and do whatever their primary care physician recommends to them. What we get back is just a form that says I went and saw my provider. Um I I I'm doing what they said. They check me and I'm not a tobacco vape user. If they check both those boxes and bring that back to us in HR, then for the next year they get a $50 per month rebate. So they get a wellness incentive. They earn that incentive back off of their premium cost.

So I think what Jeff was asking is in the email we talked about there could be some savings. I think it's a lot for the city potential savings, but there are some prescription savings and programs that we don't currently have that can help employees as well.

Right. So on the pharmacy side, we talked a little bit about with like Zeralto with Costco, you know, they'll they'll outsource that on a mail order to them and have delivered right to their house. And now they might be paying $200 because that's a a specialty drug a month in co-pays and then go to zero. So there's other uh we just did one out in North Carolina. Um it was a uh individual they they had it was a pediatric hemophiliac. They were on a drug called him Libra. 740 grand a year is what the drug cost and they had a laser. We were able to go in and using what's called patients assistance programs. So the United States is the only country in the world that subsidizes research and development for pharmaceutical companies. In exchange for that, there's programs out there that you have, if you qualify for them, which the income limits are, you know, 200 grand a household on most of them, you can get those drugs free. So, it's at zero cost. So, like that particular drug, the patient was paying $8,500 a year for it and their cost. Obviously the the employer was shouldering the other 720K.

Wow.

And both of them went away 100% for both of them. So the employee went to zero cost, the employer went to zero cost. So 740 grand savings just like that. But like Smith RX, our our pharmacy benefit manager, they do all that, gather that information, and file for that. The employee doesn't have to do that. all the employee might have to do is say, "Hey, this is my household income and then they're off and can do everything else themselves." So the savings that they could have on these co-pays, the people that have high co-pays because you look at so you know, Mayor Hegger, you were talking about, you know, $1,000 a year, that's a ouch, you know, that's that stinks. But if they can get rid of a $200 co-pay and even bring it down to 75, they're saving 125 a month right there. So now all of a sudden, you know, they're $1,500 better off. Now the other side of it doesn't hurt as bad. And that's where the potential is for both the city and the employee.

Scott, this would be good info because we're going to get asked questions. Why? Why am I paying more? And a little cheat sheet more than this. But to answer questions like that, Thursday, that would be helpful. Thursday there, there is when we go have open enrollment, Scott will be here to answer those questions and go and we we go through that. Scott does Scott's team does a great job of going ahead with Shauna and and walking all the employees through this stuff. So,

we'll have two meetings at 10 and two. We'll also record one of the meetings and we'll put it on employee navigator which is your guys employee enrollment site that we provide and so the spouses can go on and get that too. So I mean we we figure out you know you know there we have two lovely ladies here but it's the it's the women that end up doing a lot of this

you know and so if they can they can go click on that and watch that. I mean, when people call the office, it's usually not the husband. It's usually this the wife that's calling getting stuff straight and saying, "Hey, we got this, we got that." Or, you know, the husband would drop it by here and fix this. So then my next we sign up for a year or if we do mean you do a do a yearly renew just like we always do, right? Okay. Y um and we can see where we're at after. Yes. Right. Maybe you may be well enough you want to go ahead and

that's what I was looking for. Some kind of a report card where we know where we'll be able to tell what we saved in pharmaceuticals. Will we be able to see what we saved in claims as far as that goes?

That's the other beauty of it is now you know we get very limited data in my opinion and slow data. every time we get a three-month lag. And it's frustrating because now we'll get it daily. We'll be able to click on and say, "Oh, wow. You know, Jeff went to the uh the doctor, you know, three days ago and the claim just came through today." We'll know it that quick. So, we'll be able to track that daily and you can say, "Hey, you know, Darren, bring a report where we're at, you know, three months from now." You know, May 1st, first meeting in May. I'd like to see where we're at on this, this, this, and this. And we can show you how many ER visits you've had, how many urgent care, how many tele medicine, everything. And the other things that we'll do that we'll tweak with our plan to make it more user friendly is we'll go in and say, "Okay, mammograms and colonoscopies, we will not have pre-authorization for those anymore. We'll get rid of that. Right now, they have that." Well, guess what? Nobody's going and getting those for fun. You know, it's it's not. But a lot of people, they won't go get a colonoscopy because they hear the nightmare. Oh, they found two polyps and I had to pay two grand for it. Well, it's a little different with the city because we have a zero deductible 100% plan. But we don't want it to be a hassle for them. I'd rather prevent the colon cancer. I'd rather prevent the the breast cancer because again, if we can make it more user friendly and we're not hurting our cost as a city or actually being proactive with it, by all means, that's what we want to do. And those are the little tweaks that we'll be able to

do. We'll be able to say, "Okay, guess what, Scott? You you're taking this brandame drug. You've been taking it for five years. You're just not being very bright about what you're doing. You can take the generic that does the exact same thing, same therapeutic class. You can take it for zero and you've been paying 25. You know, I just saved 300 bucks. And who would you have?

So Smith would do that all too. I mean, they'll they'll have it all set up. You go to your pharmacy, you roll into Traders, Walmart, Walgreens, whatever. it'll be on there that you know hey this high blood pressure drug you can substitute this fart and go and your doctors 99% right substitute a will prescriptions so your pharmacist can can do it on the spot and if it's not well guess what then you're going to go back to your doctor and do that the other thing we'll do to help the employees transition that is we'll have a 90-day segue farm to where if they go. Jeff goes to the pharmacy and gets XYZ drug and then he's going to get an email or letter or text that says, "Hey, there's a generic alternative, you need to start taking this or reach out to your doctor about it. If Jeff goes next month, he's going to get the drug just like he is now. Third month, he's, you know, he's going to get another letter saying, "Hey, didn't do this yet." Third month, same thing. Hey, guess what? Next month, you're going to go and they're going to decline it. So, next month you go, Jeff, you know, putting it off, putting it off. He goes in and all a sudden the pharmacy goes, "No, you're not you don't have coverage for that. You got to go this drug." Now, you're on the generic. So, if you're taking a drug that maybe the generic drug has a capsule that has red dye in it, it reacts adversely with your high cholesterol medication. Well, guess what? Jeff can't take that. So, the doctor's going to say that and then Jeff takes his regular drug again. So, you can still get your regular drug, but we're not going to let people just mindlessly meander along. And but we're not going to have them walk in day one and go,

"Oh, wow. My drug's not covered. Shauna, what's wrong with my plan?" You know, and it's going to be, "Hey, here it is. This is what's coming." We'll explain that. So, are these saving savings uh are they the same for full-time employees and and part-time? Yeah. Partime or not? Parttime or not? No, only full-time employees. That's why she said 122. Yeah, that's we do have we do have a handful of people that that do not take our cover that do not take health coverage. We we have about five that wave our coverage. They have coverage, but it's all full-time benefits eligible employees.

And um I wanted to just clarify too that there's some hesitation from the HR office. Obviously, we will see more claims than we have in the past, but we will we will do everything HIPPA compliant. Um we'll come to you with needs for me being named a HIPPA compliance officer, things like that. My office will become um a little more locked down. It already is. Um and it will be very limited on who can see actual claims information. What we will get will be an aggregate that will be sent for um they will send a bill with all of claims, but that will be sent through my office and be um redacted so that when it goes through to be paid, it will just be dollar amounts. Why would we have more claims than before?

Um the claims will actually we currently we pay the HA which is just the deductible and co insurance amounts we we see those coming through um that we pay out of the account but in self insurance the actual claim every time you go to the doctor will be paid by the city directly to UMR they will pay the provider but we will pay UMR and then they will pay the provider. In the past, it was a hybrid between Scott's office and Shauna because we just did the we just covered the H because it helped bring the overall cost down. That's why we had a single was at 5,000 and the family 10,000.

Think of it this way, Steve. Before our stop loss was 5,000. Now we're going to take a larger risk at 100,000. So there's more claims that come through before the reinsurance kicks in. Hopefully we never see the reinsurance kick in because then that means we're running well. We're healthy. So that's there'll be more activity. But even with Shauna's stuff, we can redact names. We can redact diagnosis provider. We can we can redact whatever we want. So if she doesn't want to ever see a name, she doesn't have to. So that way if she goes and says, you know, all right, Tim, you haven't been doing what you need to do. I'm going to have to let you go. And you can't come back and say, well, you knew that, you know, my family had these claims and that's why you did that. No, you know, here it is. Here's our procedure. Here's our contract. We never see any name. And you insulate yourself from that. And when it goes to finance to be paid, they never That's all. We can function with what we call employee ID number.

Wow. The the nice thing learned a lot tonight, didn't you? Yeah. Yeah. It's the nice thing that you do. You can you can slice and dice the data any way you want. You know, if we want to have a lunch and learn because we've got a ton of people that are diabetic or high cholesterol, we can drill down to exactly how many members we have that that applies to. We can have donuts and bacon and show up with some donuts and bacon. We're ready to go.

But it so much more control. you know, if we see that our ER usage is higher than it needs to be, well, maybe, you know, we send out some flyers and say, "Hey, here's where the urgent cares are. Here's the tele medicine." You can react like that instead of three months late. You know, I want to ask for something that we don't want to. I mean, I know we get a financial report every meeting or every once a month or whatever, but to me, I just the report card for that would be advantageous. I think I can Yeah. aggregate versus what we're hoping to be at budget-wise, month by month. Tammy,

right? I mean, I we can't make a change. I mean, because we're we're going to be in for the year, but I'd sure like to see rather than come here next December and be like, you know, look, I told you so. Or, oh, you were pretty close. But, you know, like you said, maybe, you know, every 3 months or something like that that we know where we stand. Do quarterly. I would say quarterly would be quarterly I think is a great benchmark to do. um you know then can you increase your aggregate then or I mean I don't know is there there's nothing to change you're still locked in for the year and you know you can't say man we're we're rolling good I'm going to up my bet right it don't work that way

no but at renewal we can do that we can say hey you know what we we can look and say you know we don't have anybody that was even close to that 100,000 we can go to 125,000 save some money on the reinsurance premium premiums and that's going to be a good risk. We can hit 125,000 three times and still break even. If we hit it a fourth time, it was a bad deal for us. But, you know, because we'll look at and say, "Okay, we'll save $75,000." If we go to 125,000 from 100,000 stop loss, then we know our threshold is we're gambling that we're not going to have more than three people meet that $125,000. So you can really drill it down and

you won't know that till after the year's up. No, you won't. But we'll we'll know we'll know who's tracking and we'll know if they've got, you know, especially on the pharmacy side, we'll be able to see, you know, if they're taking a drug that's, you know, 15,000 a month, we know they're going to track 180 grand. And but the other thing is any drug that comes through that's over $350, Smith RX is going to flag and they're all they're going to pay attention to that. So if I go to the doctor and I get a new drug and it's I go to the pharmacy and fill it and it's over $350

red flag goes up, they're going to send me a letter and say, "Hey, we could do this, this, and this to lower your cost and copay and also help the city." Got you. Yeah. The biggest thing Al's all over it is those the stop losses and then the guarantee of no no new lasers ever perpetrated. That's to your point that's where the county got in trouble from that. But Mark,

you've always said we can't be in a real estate business because we can't use the city's uh citizens money, but in this case, we can and gamble that we're going to do a better job for insurance, right? Thanks for all your hard work, Scott. No problem. Scott said the word gamble. And you too, Sean. I've never heard you say gamble. You can do self insurance. Okay.

Yeah. Yeah. It's and I get geeked up about it a little bit because it gives me more tools to help you guys. And I get more information I have and the quicker I get it, the better I can help. Well, this is tough to admit, but an hour ago when I read the email and said self- insurance, I'm like, I'm coming here and saying no to that. But I guess it makes sense and it's the right thing. So, let's find out. I'll make a motion. There you go. Second. Well, there you go. Motion by Bear, second by Paty to accept, I'm guessing. Yes. Okay. Uh, anybody else want to comment or ask questions, guys, while we

while we can? Sounds good. Let's vote. Do we need to do this individually? Good. All those in favor say I. I. Opposed. Unanimous. Thank you. Thanks, Scott. Thanks, Shauna. Thank you, guys. I just need a motion to adjurnn. Please make a motion. Second. Motion by Halter. Sec or Holtmire, second by Coulter. All those in favor say I. I. Ask