City Council Committee - Regular Meeting

Good morning. Welcome to the August 31st. Can everybody hear me? Welcome to the August 31st, 2026 Healthcare Oversight Committee meeting. To ensure we capture accurate and comprehensive minutes for this meeting, I ask that you state your name before you address the committee members and other speakers on the agenda. Please mute your phone during the meeting. I hereby call the meeting to order. I will now call the roll. Chairman Chase Carlisle. Present. Mr. Matthew Tomek. Here. Mr. John Covington. Here, sir. Mr. Cameron Stevenson. Mr. William Lauchay. Mr. Richard McBride. Mr. Phillip Funderburg. Chief Fonda Fouchay. And Mr. William Bird, I am present. So the first thing we're gonna talk about is we're gonna move to the fund financials. Since we're gonna do that, thank you. And that's the one with the financial on my screen. Okay. Can you change it to, I'm sorry, can you change it to the next, the other one? The one that's on my screen.

I apologize. Thank you, sir. Thank you so much.

So I'm gonna turn it over to control the Miss wide for the financial

Good morning. I will now present the financials for the Health Insurance Fund and the OPEB Trust Fund for the period ended June 30th, 2026. And for the record, I will advise everyone, all listeners, that the financials are preliminary since we are currently under audit for fiscal year 2026. For the 12 months ended June 30th, 2026 for the health insurance fund, total revenues were $99,428,632.15 comprising of employer premiums of 74.5 million followed by employee premiums of 13.855 million and then pharmacy revenue of 11 million. Expenses totaled $106,692,207.44, comprising primarily of health claims expense at $87 million. The change in net position for the year ended again. Its preliminary is... a negative $7.3 million, bringing the total net position for the health insurance fund as of June 30, 2026, still at a positive balance of $21,671,798.24. As you can see, compared to last year, the revenues are above what they were at this time from last year at $92.3 million. However, you will note that the expenses are also about the same level above at... about $8.5 million. Moving now to the OPEB Trust Fund, total revenues were $28,889,409.15, comprised as the same for the Health Insurance Fund, largely of the employer premiums at $21 million and the employee premiums at $4.7 million. Expenses for the fund total $30,239,887.39, with claims expense accounting for approximately two-thirds of that amount at $20,236,000. The preliminary net position for the OPEB Trust Fund as of June 30, 2026, is $26,098,197.98, which is about $6.5 to $7 million above what it was at the end of fiscal year 2025 at $19.5 million. Our next couple of pages are just analyses in a pie graph format of the various revenues and expenses in both funds as expected, the health insurance fund account, the employer premiums account for approximately three-fourths of the revenues at 74 point, almost 75%, and it was about the same at the end of June 30th, 2025 of last year at 75.2. Employee premiums at the end of fiscal year 2026 accounted for almost 14%. Expenses, as we looked at the dollar value just a moment ago, the percentage-wise health claims expense at the end of June 30th were $86.5 million. The percentages are about the same as we moved to the OPEB fund. You will note the employer premiums are also about 75% of the revenues in that fund, followed by employee premiums at 16%. Expenses account for almost 89% of the, I'm sorry, the claims account for almost 89% of the expenses in the OPEB fund. Our next analyses are a breakdown by account for both funds of health insurance and OPEB. It shows the actuals as of June 30th, 2026, the preliminary values and in comparison to the same values for the end of fiscal year 2025 with the variance and then also the funding budget for all accounts. Our final analysis includes an analysis of the claims expense for both the healthcare and OPEB funds. Again, as noted at the beginning of the presentation, health insurance funds claims totaled $87,718,954.94 for June 30th, 2026 fiscal year total and then Correspondingly for OPEB, the amount is $20,236,813.79. These are the preliminary financials for both the Health Insurance Fund and the OPEB Trust Fund as of June 30, 2026.

Do any members have any questions regarding our health care financials? Seeing there's none, I'm going to ask Jonathan, can you, is PWC on the call? PWC was not able to make it today. So they're on call virtually. Abby, are you there? I'm here. Jonathan, can you put up the PWC dashboard, the other attachment? Thank you so much. Abby, can you speak up? I think speak up a little bit because I bet I can hear you.

Can you all hear me?

Barely. Can y'all hear? Okay. They can hear you. Okay.

Hi, Abby Cape Romero. Thank you so much for allowing us to present virtually today. I'm going to walk through the dashboard on a calendar year or plan year basis. Starting with the dashboard in total from the period from January through June to comparing 2026 to 2025, the total number of employees and retirees is up 149 individuals or 2%. The number of covered members in total, including dependents and spouses is up 124 individuals or 0.8%. Total plan cost is up 2,240,000 or 4.8%. Used HRA dollars are up $351,000 or 10.9%. Employee premium share is up $213,000 or 2.3%. And net city. I'm sorry, I'm gonna try to cut you off. I'm sorry, I apologize. The documentation,

that you gave us the print off is 2025. Okay, we apologize committee. So please look at the screen. Ebby, can you tell us what page you're looking at? Because we're looking at the screen. The printout is a little different.

Yes, I am looking at the one that says total program cost.

Okay, all righty. Go ahead, Ebby, I apologize.

No problem. Thank you for reorienting us. So net city cost year over year is up $2,378,000 or 5.9% for a net city PPM cost that is up $34 or 3.8%. Moving into the medical claims experience, Year over year trend is 6.7% compared to 2025. And the two year medical trend is 8.6 on average per year, which is in line with market, which is 9% annually. And then for total pharmacy, pharmacy trend is relatively flat at 0.4% year over year in total. And the two-year trend for pharmacy is 8.7%, which is slightly lower than the 11% we're seeing in the market, and primarily due to expensive brand name medications for inflammatory conditions and cancers.

Next, we have it, Brooke. Abby, can you make sure, because we don't have a piece of paper in front of us, can you always tell us what section you're in so people can follow the screen? Thank you.

Moving into the active program cost, similarly, the number of covered actives is up 1.3%. The number of covered members, including dependents and spouses, is down 1% on average for a net no change. Total plan cost is up 3.8%. Used HRA contributions are up 12.5% on the active side and employee premium share is up 1.1% on the active side for a net city cost that is up 5.1% or 3.8% PEPM. Moving into the active cost trends for medical claims, Medical claims for actives are up 6.3%, and the two-year trend is 11.4% on average, which is higher than the 9% that we're seeing for benchmarks. On the active prescription drug side, the year-over-year trend is- Excuse me, Abby.

Excuse me, Abby. Councilman Keller asked why.

I apologize, I'm going to need you to relay that in a microphone because I'm not catching it.

Okay, give me a second.

What's driving our deviation from the national average, from the trend? Do you have any insight into that or are we still digging into that?

You know, that's the two-year trend. Year over year, you're looking pretty good with the 6.3. That two-year trend of 11.4% is a bit higher. Last year, especially in Q1, there was some more high-cost claimant activity, which is the primary driver of that two-year trend.

So would it be fair to say, if that didn't occur, that we should normalize back out? Likely. Yeah. Likelihood to normalize back out. I'll use that word. I'll use the word likely.

Yeah. Without that, you'd be pretty close to the national average.

That's what I want to understand. Thank you.

Mm-hmm. So then moving into the active pharmacy costs, the year-over-year trend is 2.4%, and it was a two-year trend of 9.2, which is slightly lower than the market pharmacy trend of 11.5 annually. In total, moving into the retiree program costs, Top section is very close on the retiree side. So for active, the net city PEPM cost was up 3.8%. On the retiree side, it's 3.9%. So fairly similar. In total, the number of covered retirees is up 67 or 6%. The number of covered members for retirees is also up 6%. Total plan costs is up 9.6%. used HRA contributions are up 0.7%. Employee premium share is up 6.1%. And then net city cost is up 10.2%. And as I mentioned previously, the PEPM is up 3.9%. Moving into the medical claims and HRA spend, the retiree costs are up 8.2% year over year. with a negative 3.4% on average over two years. So significantly lower than that national trend of 9% annually. That's in large part just due to the fact that the retiree population is relatively small and a fraction of the active population. So you're just going to see more fluctuations from quarter to quarter and year to year. And then for the prescription drug costs for retirees, those are down 8.3% year over year for the first two quarters. And over the two year average is 5.3% per year on average. And similarly driven by high cost drugs for inflammatory conditions and cancers. Finally, we have the utilization services, the utilization for active. Overall utilization of services is up 8.1% and primarily in inpatient admits and physician administered drugs. Outpatient visits are up slightly with a 3.7% increase and a little bit different distribution year over year. And then physician office visits are up 4.3%.

What's driving the inpatient visits to clip up like that? Although I guess it is more expensive to keep somebody in an ER. But why is that clipping up?

We did see a little bit of an increase in more visits intensive surgeries that require an inpatient stay along with the surgery was one thing that stood out. Another thing to keep in mind too, similarly with like the population sizes, there's so few inpatient admits relative to the population that even a, you know, a handful of additional admits year over year can cause a larger swing.

Yeah, that's really interesting. Okay. That's very helpful to understand. All right. Thank you.

Abigail. Yeah. Uh, Hey, it's Matthew Tomac. I had a question on the other 635. What, what does that account for? Is that like physical therapy visits and that kind of, uh, under and under that's other outpatient visits.

Um, there, you know, the big categories we have pulled out, um, some of that is urgent care visits. Some of that is, um, You know, we can have that as a follow-up. I just looked at it. So we can add that as a follow-up to clarify what categories go into that.

Okay. Thank you.

I also wanted to call out to some of the larger swings that we're seeing in terms of the cost per service. Especially when there's a decrease in services, you find that that's usually a decrease in the less severe services. And so you end up with higher cost per service for those that are still using, say, still going in for an outpatient surgery. In terms of prescriptions, total fills are up 1.3%, and specialty fills per 1,000 are up 11.1%. with minimal changes to the cost per script. The generic utilization rate is down just slightly, and the percent of scripts filled via mail order is also down just slightly. The swing looks bigger, but it's really going from 0.8 to 0.7. And then finally moving into the quarterly highlights, The Blue Rewards participation data is not currently available since there's been a change in wellness platform with Blue Cross Blue Shield of Tennessee. However, in terms of wellness redemptions, those are up or so, sorry, those are down from 59% to 32%. And that is likely attributable to the late arrival of the wellness guide, but we expect those to pick back up in the latter part of the year. And then on the right-hand side, we have the utilization of the cities on-site and near-site health centers. And we're very pleased to see that the utilization of those has increased quite substantially year over year, especially in some of the whole health categories like behavioral health and physical therapy and the registered dietitian. And we also are seeing especially compared to last year, kind of the trend leveling out. And we think that's likely attributable to the services that are now available through the onsite that's carving out some from the health plan. Any additional questions?

Right now, they have no additional question, but please hold on until the committee is over. So they might have some questions at the end. Thank you so much.

Thank you.

Thank you. John, if you could pull it to the presentation slide. Thank you so much. So we just got through with the healthcare dashboard, excuse me, healthcare dashboard, healthcare funds. We're going to turn over to our next presentation, which is going to be a wellness update. Ms. Ashley Brock.

Good morning. For our first slide, we are looking at our metabolic health program. For our diabetes program, we have eligible 1,533 and 325 have utilized care. For prediabetes, we have 1,244. We actually are up with our utilized care by 23 participants who are now in that program. For hypertension, we have 1,686. We also gained four employees who are now part of the utilized care, bringing that up to 133. Once an employee is identified, that could be assistance of any of these programs. There's a five-month outreach campaign that provides at least six direct emails and eight general emails. that hopefully will get our employees more engaged with these programs. And we also understand that they may choose other care providers for these illnesses, but we are seeing increased utilization in this program. Our next slide over is regarding purchasing power, which is a benefit that allows employees to buy travel, different wellness resources through this purchasing program. There's no interest rates. We do not have any hidden fees and it's paid through payroll deductions over time. And the next slide will show the utilization. And so the pink bracket shows quarter one and followed by blue, which is quarter two. So we have had about the same amount of orders in both quarters and first time users has gone to 36%. We do expect an increase around the holiday season as people Get ready for that area. So currently we have 1,226 registrations, 977 orders, and a total amount of 317 users. And the next slide shows what the employees are actually purchasing through purchasing power. And largely, the amount is home essentials, which includes electronics, furniture, TVs, home improvement, and automotives. The pie chart provides more details on the specific types of purchasing for employees. Okay. And the next slide just highlights that with purchasing power, employees are only allowed to use this service for only 7% of their salary. So this makes sure they're not overextending themselves with this new benefit. And our overall utilization is about 38%, which is, well, the average is 38% and ours is a little bit higher, but we are still in the range of their benchmarks. So that's an example of someone who has a $50,000 salary, how much they could purchase through purchasing power. And lastly, we have the event coming, Family Fun and Fitness Day, which is September 12th. So we're excited to have all our employees, family, retirees there to participate, get free resources, free food, and free fun. It will be September 12th, and it also will be our kickoff for open enrollment. So you can get everything done in one-stop shop, and we're super excited and hope to see you all there. Thank you.

Any questions for Ashley? I wanted to give her a shout out to her team. Friday, we had Nana one day. I don't know if y'all came, but it was a success. She did amazing work. It was a joint effort with our counterparts over at Sheppard County. Her and her team did an amazing job, and I wanted to thank her and her team publicly. And I know we have thanked her in email privately, but I wanted to give her a shout out to why she's here. Thank you so much, Ashley. We're going to move on to Care ATC, if they can come up. I wanted to bring Care ATC so they can speak to you personally. Care ATC is our clinic management organization that runs our on-site wellness center. Instead of me talking about the wellness center, I wanted to bring them up. And so you will see them going forward to this committee. Okay? Person on the way, Lynn.

Yeah, thank you. Good morning. My name is Raelynn Whittingham, the Client Success Director with CareyTC. Just want to kind of go through a little bit of an overview regarding our health center utilization, looking at the Poplar Avenue Clinic to start. And this is a comparison looking at Q2 2025 versus Q2 2026. Looking at the right-hand side where we have the amount of visits for 2026 with 2,092. And then compared to 2025, in that same quarter, we had 1,323 total visits, looking at an increase of almost 60% from that year to the next, which shows obviously a substantial utilization in these clinics as we're kind of moving forward. And also just to highlight, as utilization obviously grows, we're going to start to see more no-shows with our numbers, which is absolutely normal. But you'll see also in that top right corner that there was 231 no-shows at the clinic, at the popular specifically, versus 120 from Q2 2025. So again, even though you're seeing that increase, we're looking at different measures to make sure that we are doing the follow-up and making the phone calls to our patients the day before just to remind them of appointments. If they engage in our mobile app, they also get reminders as well to remind them that that appointment is coming up 24 hours in advance. So we always try to make sure that we keep close check on this if we start to see it go to a higher trend but right now it's with a normal book of business that we have through carry tc so this is a normal trend that you see so if it starts to get higher we obviously will look at other options as well And just the box in the middle area too, so you're looking at, it's just breaking out. So we call them divisions. You guys call them groups. But this is just kind of showing where you're capturing most of your utilization, which is obviously through your full-time employees. You can see you have substantial growth with 1,610 visits from that full-time. And then going to the retirees, we've had a total of 236 in Q2. Part-time was 215. And then we have some of the airport authority non-health plan, which is roughly making about 31 of those visits. So I'll pause on this slide for a second. Do you have any questions on the Poplar Avenue one?

Rescheduled.

Correct. Yeah, exactly. Good question. And then the next one, just looking at City Hall. So same thing, you'll see that there's been substantial growth from Q2 2025 to Q2 2026. In 2025, we had 569 visits. We've grown in Q2 to 752, which is showing a 32% increase on your visits. um the no-shows is is much lower obviously at the city hall but a lot of the visits that are captured over at the popular location also include our total health solution which is our registered dietitian our mental health and our pt um so there's quite a bit more utilization on that clinic so that's why you'll see that it's a it's a higher no-show rate um And then looking at the comparison again, it's just breaking out where you have a majority of your groups coming in. Full-time, obviously, again, is showing that you're making up the substantial utilization, going from 519 to 684 with the full-time. A little bit of growth with the part-time over that year from 30 to 39. And then you have your retirees, 25. And then again, capturing some of the contractors that are coming in. So any questions on that one at all? Okay. And then the last slide, just wanted to really highlight, and we have three different groups, obviously, with our total health solution, including registered dietician and mental health, but really just wanted to highlight the substantial growth with our physical therapy, especially because we just recently went through an expansion, and we hired a second physical therapist, but In the quarter of 2025 to 2026, you can see we've had some really good growth going from 361 visits to 551, so a 53% increase in utilization in that short time. And then looking at unique patients, and unique patients is defined as if that 81 people contributed to, or I'm sorry, 125 people contributed to 551 visits. the unique patient is just accounted for one time, but they're making up those visits. So you see we jumped from 81 to 125 from 2025 to 2026. So key takeaways, physical therapy remains very strong. year over year are, and we have actually, we have a waiting list right now that's three to four weeks out. So it's, and we've been in conversations about looking at adding additional PT, especially because if somebody's out sick, we don't want a bottleneck. We obviously don't want patients to be waiting three to four weeks to get in, but we're also talking about adding Saturday hours. So it would be very beneficial to look at adding a third one. So we've been having conversations about that. So any questions on this at all? For mental health? So right now, mental health is actually at a capacity. So I do have some capacity numbers. So PT is averaging between 88 and 90. And just so you understand how Care ATC monitors that, that if we start seeing a trend of between 70 and 72% is when we start having conversations with our clients to say, hey, listen, we're starting to get to that threshold because by the time you start recruiting and open up the positions, you're going to be maxed out. So we start having conversations then. Mental health in July was 87.7%. And then registered dietician was 83%.

If I can add to that, we do have several ways that we help mental health, not only with the clinic, but we help Teladoc, we help concerns. So they're not using this particular facility here. They do have other mechanisms to use for mental health as well.

Right, and not to give anything away, coming attractions, the police department has put up a huge focus, and I think we're going to see some programs that... So I think this is really good, a huge step, especially for first responders to become more comfortable in discussing these things. So thank you.

Hi, Matthew Tomac with FIRE. Could y'all send us some flyers or images or stuff for us to mail out, email to our membership, active and retired? Because I haven't seen anything in city email lately, I don't think.

On mental health or physical therapy or just...

Employee wellness in general. Okay. Or the employee wellness center in general.

There's some stuff coming out recently, but during this whole month, we've been inundated with a lot of... Yeah, I know.

I know open enrollment's kind of the priority right now, but I'd like to keep hitting that... with the retirees for the email addresses that we have on them.

And there's going to be some new flyer coming out about for retirees that we worked on that you'll see. We would make sure we get the retirees out, but also other information out for you too. If you'll send that to me, I'll get it out. We will do. Any additional questions for... Okay, thank you so much. Thanks. Thank you. We're going to move on to the health care program status slide. So we brought back this slide. I think that was asked to bring back this slide. And it's the same trend over year, quarter after quarter, that our diabetes, inflammatory conditions, cancer, weight loss, and skin condition is the top five in pharmacy conditions in our health care. Just the same over and over again. So the next slide, same thing. This is from 7-1-25 to 6-30. The top five, as always, these five has been trending, they're ready for several, several months and quarters. Next slide. We talked about these are our five signature spins on our different things with, you know, Majawa is the leading script. but go on to weight loss, and family conditions, these are the drugs, brand name drugs on the left, and then the indicators on the right, and then the number scripts, and the paid claims. Any questions about those?

Yes. John Covington, MPA, and I may have dreamed this, and I don't know if this is even feasible. Did we ever talk about looking to some ways in some of these weight loss drugs to make them covered in a different way, or cheaper, just because the health benefits for diabetes and all these things seem to be long-term and hopefully will lower costs, ultimately, especially in our retirees, which will be myself one day. But did we ever have talks about making those more affordable or covered or anything of that nature?

Well, honestly say, we're going to talk about that pretty soon in the slide. If you bear with me, we're going to talk about the GSP1s, weight loss. Yes, sir. Yes, sir. In the slide. And so I think it's about six or seven more slides. We're going to talk about that, okay? And then hopefully I answered your question then. No, William, let's do it now. If not, please break it back up, okay? Okay, thank you. I appreciate it.

So our... These prescriptions, the top 10, do they coincide with the top claims as well? Yes. So these are the claims and pharmacy?

So these are the pharmacy scripts right here. Right.

So we may have, so orthopedics may be the top claims on the plan in general, but they're not going to be listed here because if somebody breaks a bone, they're not going to get one of these drugs. So I guess I'm trying to find out. what the top 10 claims are in general outside of pharmacy.

I got you, I got you. So I don't have the answer for you right now, but we can get to that.

I'm just curious to know what the top 10 claims are in general outside of the pharmacy.

Okay, we can start bringing this into the thing, into the slides, okay?

Because I'm sure blood pressure and that kind of stuff will be a part of it.

Mm-hmm.

Could be orthopedics, could be cancer, could be, you know, I'm just curious.

Yes, sir. That's a good question. If you allow me time to get back there and then we'll start having a slide with that. Okay. And so we're going to move on to the next slide. And same thing with the pharmacists, it's the same trend, the resistant drug updates for 7-1-7-26. Any questions outside of this? We can move to the next one. We're going to talk about a health care plan update. Next slide. So many of you have served on our RFP. where we did life insurance and we did, excuse me, accident of the deaf and dismembered. So Securian was picked as our life insurance vendor. And they are starting be effective January the 1st of 2027. We are in implementation stages right now. So really, it's not going to be a change to the employees. They don't know who the vendors are. They just see the products. But Securian will be our vendor of selection starting January 1st of 2027, which will handle basic life, retiree basic life, supplemental life, dependent life, and term life. I want to thank you for the people who served on the committee and helped us pick Securian. Any questions about that one? This is only a formality to let you know the information. We go to the next slide. Our vendor of selection was for our short-term disability and FM&A process was standard. And they were selected by the committee. They handle our disability claims, coordinated leave and absent information. They'll be effective January 1st of 2027. We're in implementation stages right now. There will be some changes on how the leave or absence has been conducted, not for any processes, but who they call. And so they would be communicating with those individuals who's currently on leave of absence and then you're gonna see more information to come on who to call going forward. Any questions about that? So just want to give you an update on the next slide, please. Thank you so much. We had launched July 1st on demand pay. And so this is where people can take some portion of their salaries and get it early. We have 543 active employees enrolled. Some put 6% of eligible workforce enrolled with the first two weeks. and we're seeing a steady incline of increase. You know, we're still kind of early to pick out, but if you go out, this is a breakdown by divisions. And so we have that breakdown of divisions and we're gonna keep on monitoring it just to make sure that it is working fine and that we don't have no repeat offenders using the platform. Any question about on-demand pay?

Yes, go ahead. John Covington, I can't help but see police officers are leading the charge and not particularly excited about that, but no, we'll see. And we've talked about this because we, You know, in the past, we have a lot of officers come to our charitable foundation, and, you know, financial mismanagement is not what we're there for. It's, you know, major life events. So I'll be interested to see, and I know we'll talk and try to target if we find particular officers that frequent flyers, and maybe there's other ways we can help them to get caught up with whatever it may be. But I'm glad to see these numbers, and so...

And I just want to say, too, that this is the whole division. And so we will have to break it down by commission position as well. And if you're looking at the makeup of the city, this is part of the trend of the makeup because police overall in the division make up the big population of our employee selection. So 160 employees. out of the norm of the division ride, is partly in line with the makeup of the city.

The good news is looking at the numbers, officers with four years of less are over 500, which is a testament to the work of the city and the department in recruiting. That's a great thing. We're also bringing in a new cohort of generational younger officers. It would be good to be able to track how many commissioned because we want to make sure if there's opportunities to help guide them on financial planning, what that might look like down the road. As I said, it's just a whole new generation coming in pretty fast. In our experience, some of the younger have had some challenges balancing. Basically, we don't want them to build their lives on overtime. If overtime is not available, you should be able to pay your bills. That's something we can do. I think this is a good program.

And we are definitely looking in, I mean this is a great tool to retention because people in the younger generation want to have the ability to get their money faster and sooner, but we're also looking to build up our financial wellness component. I know there's some efforts to do that and you can hear more of our efforts in HR to build up our financial wellness component for the whole city. We're doing different things to do that. We hope more to come on that and more opportunity, not only for the commission, but also non-commissioned employees over financial wellness. We go to the next slide. We're gonna talk about our lifestyle statement account. As of July 1st, the number of people who were eligible is 6,933. Part-time, 244. Full-time, 6,689. The number of people who's engaged so far is 431. They mean they have been engaged, completed at least one transaction on a thing. There are several people who have activated their accounts but have not did anything. There's 790 people. Some people who just have logged in, that's 1977. The numbers don't match because they're totally different components. So it's making trends. So it's a real part to see more engagement, more people participating as we go farther in next year. Thank you. Same thing with urban centers. We go to the next slide. Family Care Benefit, who is sponsor, who is TPA is urban centers. Same number of people who right now was eligible July 1st. From July 1st to July 31st, we have 44 people to sign up, 18 book services so far. Okay, but we are doing more outreach. All our vendors from Express Rages, Urban Cities, and Bene Pass have been attending all of our events, and so they're going to be attending some of our events on Family Fun Fitness Day to try to boost up the engagement. Any questions about that so far? Let's go to the next slide. Thank you so much. We're going to talk about our open enrollment. Open enrollment is here. It starts September 12th at our Family Fun Fitness Day. It's an active enrollment. All employees must enroll from our full-time, active, part-time, and our retirees. Like I said, kickoff is Family Fun Fitness Day. We're going to have a beneficiary campaign. We've been doing this every year. It's very important, and we definitely need everybody's help to encourage everyone to update their beneficiaries. And you know, the people on the committee know how important it is to have updated beneficiaries. And we tell them every year, but sometimes people don't really care, but we need the support of the committee to encourage all our active and our retirees to update the beneficiaries. We're going to send letters out, and we're going to talk about engagement by HRVPs to let them know who have not updated their beneficiaries in a while. The next page, we are doing a dependent audit, which we call DAVA, Dependent Educative Education Audit. It's required documentation for everybody that have a dependent, which is a spouse, a child, or a loved one who is court-ordered to be on our insurance. It will require documentation as a marriage license, social security card, divorce decree, birth certificate, or quota-determined guardianship if applicable. Right now, We audited 3,525 employees, okay? Excuse me, 3,525 employees' records did not have the white crowd documentation. We sent out letters. There were 290 active employees, 615 were tari's, okay? We had sent out the letters the first time around. And then on another, it did, so we did say September 2nd, right? So when a clear, sorry, 12th, I'm thinking about Labor Day already. But we did want it to, sometimes if you don't tell the employees that they have a deadline, they won't react and wait till the last one. Even though we're going to wait till October 31st, we wanted to put a hard date on there so people could react sooner than later, and they will receive another letter in the mail. Yes, sir.

That's one of the things I wanted to ask about because, you know, officers, nothing derogatory, but, you know, they can start carpeting. And they were carpeting about that date. But I didn't want to go out there and start giving another date just yet because the whole point is to kind of get them rolling. And I'm almost, on that second notification, what date is it going to give, I'm almost hesitant to say the end of October date. It's almost like I want to set another date, because I don't want to encourage waiting to the last minute. Because that came to me, and I didn't answer any of these officers to say, I didn't put that October date out there, because I don't want to slow down.

The tracksuit.

Yeah. And so is the next date, I don't know how you guys feel. I was thinking maybe another day before October 31st. Just to... Well, the documentation deadline is October 31st. Yeah, that's the... Oh, you're talking about just... That's the... Yeah, maybe one before, just to... Yeah, I don't... What do you think?

I'm bringing my... I'm going to need... I'm going to need Scott up here who can speak more about the program.

Hey, I think that is a good suggestion. However, we need to have some more conversations. It is causing a bit of confusion. We're getting questions on every side about it. I think another way, if we decide to keep the October 31st date, is just for you guys to help us increase the urgency. Although you have until October 31st to get your documents in and get it in early.

Yeah, and that would work too. I guess we'll get pretty soon on the 12th, I guess, we'll know what we're working with and we can target our people really, really hard because, you know, I hear them like, blah, blah. I was like, look, let's just get this done. And hopefully we scare, well, maybe that's not the right word. We encourage them to as many as possible by then. Yeah.

And I think we definitely need to have a documentation on file. And I'm not going to go back to what happened in the past. People bought it in and didn't bring it in. And this is where we're at now. And we have developed a process to make sure that this happens again. Uh, and that, uh, we need certain documentation for several reasons. And I'm going to share this, but I'm still a lot of people, uh, we have to identify as he's that we have to maintain as well. This is part of the government ACA requirements. And they would cross social security numbers and we have to do another campaign. at the end of the year. Because some people file their taxes incorrectly and put different social security numbers on it. And we are required by organization to reach out to these individuals for social security numbers. So the reason we're doing a lot of stuff is to be proactive and also to make sure that we have proper documentation going forth for different reasons.

And so... Well, I guess when are you guys going to put out October 31st? Because I don't want to get ahead of you guys when you put that date out. Is that the second...

So we're going to have a meeting about it today. Like I said, we've gotten a lot of feedback over the weekend. So can I give you an answer by the end of today? Yeah, that's fine.

I just want to make sure we're all on the same page. I didn't want us to be, it's already, I didn't want to create any more confusion by us being all different. So I want to follow your lead, your timelines and dates, you know, so thank you.

The folks that received the letters, are they the ones who are missing documentation or did everybody receive a letter that has a dependent on the insurance?

No, everybody who received the letter was missing documentation. Okay.

So if you received a letter, you were missing some form of documentation.

Form of documentation. Okay.

So there were 3,500 letters that went out.

Just about, yes, yes, yes, yes.

My phone's been, as you can imagine, ringing off the hook, you know, about it and just trying to. I'm in favor of it. Generally, if you've got to show the paperwork, show the paperwork.

We've been getting a lot of people in. I've met this gentleman this morning. Every morning, they're there before 8 o'clock. They're getting the documentation in to us, and that's what we need to do. Thank you.

It's encouraging these young folks. I know I'm getting old when I talk about the young folks. To have at hand birth certificates and Social Security, that should all be And maybe they've never thought of that, but this will get them caught up, hopefully, too, is getting their documentation together. Yes.

So what do we tell the folks that, you know, I had a guy call me over the weekend. His daughter is nine years old. He provided the paperwork when he was enrolled. Now he got a letter. Just say that the city lost the paperwork or lost the verification paperwork or whatever.

I would like to know who that is because initially, and we're getting that a lot as well. I provided my documentation. I provided my documentation. A lot of it may be Social Security cards. Years ago, we were not requiring a physical copy of your Social Security card. Just give us the number. But like William said, it's impacting other programs. We're noticing the Social Security numbers are wrong. So it's best to have a physical card on hand so that we can reference that. So it could be that he did provide a birth certificate.

The documentation that they provided back then is different than what's... No.

They may have provided a number for Social Security versus a card. That's usually the case. But if you give me his name, I'm happy to check to make sure.

Any additional questions about Dava, as we called it?

I'd say diva. I think diva sounds better.

I pronounce it wrong, but it's my name. Go ahead.

We call it diva. Alicia Jones, she's leading the project, but I slip up and call it diva sometimes. So, hey, just call it. Either one is fine.

Based on some of the calls I get, I call it diva. But... And not to be cynical, but of course we're going to get some who just say, well, I turned that stuff in a long time ago, just trying to get out of it.

Please let them know, because it's really important that we have this documentation so they can have coverage.

Oh, yeah. Yeah, so we'll get it done.

This was done like 10 years ago, if I remember right. Some of the longer term folks may know. I want to say it was 10 or 11 years ago.

That sounds right, yeah.

Back during the whole insurance, you know, retiree debacle. It seems like. Gertie's back there nodding her head. Okay, yeah. She may have been here at that time. Or that was before. Well, that was just after your time.

Well, hopefully we can... take the brunt of some of these calls before they call and yell at us. We can cut it off so they don't call and bother you with it. No, thank you for all your hard work. This is something that has to be done, and I know it's not easy, so thank you. It's tedious.

I'd like to draw your attention to something that I encountered also. If y'all could be aware of employees like the officers who retired became reserve officers they were giving a new ibm number and some of my documentation did not get transferred over and there was some confusion with my paperwork in the past so because of two different employee numbers so maybe something to to watch out for

Any additional questions about this program? I didn't want to say a name because I didn't want to say the other word again. So we go to the next slide. So we're going to talk about open enrollment communication strategies. So there's a lot of information going out. We do have roadshows already set up. We have communicated with, I hope they communicated with some of the the Police Association, the Fire Association, as well as ACRE by coming out and sending up road shows. With that, we have different communication information out. So if they have not called you or anything like that, please let me know. We have my team to reach out to you, okay? So we do have, if you go to the next slide, We have several communications, several ways to enroll. We're talking to HIVPs, we're talking to the association. We can also track participation on a weekly basis, and we're gonna send reports out to the divisions, leaders, and we can also send out something to the association to letting them know how many people have enrolled. Now, the first week or two is going to be slim, you know, because it's not as heavy, but you will definitely get some information, at least by the third week, about participation. Okay? So this is kind of highlights of our role shows. We know we're in different role shows. So let people know about our benefits and our total awards. And just let you know. Great people deserve great rewards. So that's our tagline. We believe in that, and we've been striving for that. And so we want to let people know about that. And so this is a outreach campaign that we are doing. And so there's a number of people we have been reaching, and just so far, we are constantly doing our show. So if you go over to the right, August 21st and August 26th have passed, but September 25th is our next one, and October 22nd is our next one. And if you would like for us to come out there, we do have road shows coming out there with our open enrollment to the associations, and so the top team will be out there as well. Okay? We'll go to the next slide. So there's been a shift in what GLP-1's been doing. I know that there's some organizations within the city has eliminated the GLP-1's programs. There's other organizations that have changed the GLP-1 program. There are different market things right now, and there's cheaper for consumers to get the GLP-1s than organizations, okay? Because they could go directly to that. So the city... THE ADMINISTRATION IS SEEING AN INCREASE IN GLP RENTAL MEDICATION FOR WEIGHT LOSS AND DRIVING THE HOT COST OF THE CITY HEALTHCARE PLAN. CURRENTLY, RIGHT NOW, WE HAVE 2.5 MILLION THAT WE SPEND IN 2026. THIS IS THE ESTIMATE BECAUSE 2026 IS NOT OVER WITH, RIGHT? SO WE'RE ESTIMATING $2.5 MILLION THAT WE'RE SPENDING. WE'RE EXPECTING THAT IN 2027 THAT WE'RE GOING TO SEE AN INCREASE TO $3 MILLION. Right now, as of today, we have 657. That's supposed to be increasing to 2027. Excuse me. 2026 to 657. We're expecting an increase in 2027 to 827. So our recommendation... going forth right now for January 1st, 2027, is moving to a cost-effective model with divine eligibility. We are seeing trends that employees who do do GSP1s, sometimes they get off of it and they gain the way back without having a support system, right? And so what we wanted to do is have a structured rate management program participating in the support, and we're going to eliminate, just want to be clear, we're going to eliminate the rate loss, rate loss only, not the diabetes, rate loss only on our program. Okay, they will have to go do a, if you go to the next slide, one of our support individuals, which we're working right now with Weight Watchers, Weight Watchers right now, that we're going to work and subsidize the medication. And we're going to pay for the program. The medication will be subsidized at 25% of medications. Okay? And so the annual cost for the employee, estimated cost for an employee would be $3,000 a year. However, the employee can use the HRA they can use the lifestyle savings account that we have going on. So they have mechanism to pay for this. Uh, the estimated employer cost per employee was almost a thousand, but we're going to subsidize it with 25%. Okay. The estimated, uh, employer cost membership is going to be, uh, a thousand annually. So we are expecting, expecting for 2027, to spend $1.64 million. We're expecting that our cost savings for the pharmacy claims would be $1.4 million. And so this is the expectation that we would like to do January the 1st. I think it is in line with what we've seen the trends would be. A lot of employers are getting rid of the GSP1 program, and the market is changing rapidly. Every day is changing. And so we're going to be looking at this every year to see what the market would be. But this would give us some cost savings in our pharmacy claims. And I think it is the right way of going to move to more of a direct consumer product. And that's when the pharmacy is leading to. It's more cheaper for the consumer to get it than employers to pay for it. And so that's why we're moving to this market. I'm taking all questions and going for it.

So this would just be set up in Blue Cross system where if someone's prescribed one of these, they'll they'll come out of pocket 75% of the cost and the city will pick up 25%. Is that the gist of it?

No, so we're going to be communicating. So actually, GLP-1s for rate loss will actually stop from the Blue Cross Blue Shield system completely. They will have to go through rate watchers. Rate Watchers, we have a program. They will have to go through a rate management program. They will get their medication. They will buy the product, and we will subsidize it through their pharmacy that Rate Watchers has. Rate Watchers has a third-party vendor that they will use, and we will give their vendor a 25% subsidy when the employee sign up for it.

What if the doctor deems it medically necessary? I don't know if they would, but what if the member's treating physician deems it medically necessary?

Well, it was medically necessary. I don't know. I have to take that back. But, however, if it's diabetes-related, it falls into another category. If it falls into another category. To me, if it's medically related, then it needs to fall into another category. It wouldn't be considered weight loss. Right. Weight loss is supplemental. It's not optional. So I would definitely take that back for discussion.

I think this will end up being cheaper doing this way. Because if somebody, I don't know, that I knew was doing it, I mean, it could be like $100 a week to do it, and it's not covered. And if any of that was subsidized, I mean, that would – because it's going to be around right now for somebody just using it for weight loss, that could be well over $4,000. dollars a year so no i think this is uh yeah it's probably a good i'll be interested to see i think it'll end up being cheaper for for people doing it this way i don't know that i'm against it but i just don't know that like if i wanted to get on the meds i don't know that i want to go to weight watchers i just want to you know talk to my doctor and get them to prescribe it to me and well when you do that it is still yeah it'd be like a hundred Between 80 and 100.

That seems like an additional hoop to jump through.

Well, and I'm going to be honest. You can go to any organization right now, like a clinic up there, and you can get on these drugs. But they don't have support. So what happens is these people get on the drug. They lose weight. Then they get off the drug. But there's no support for them to change their lifestyle. And if you don't change your lifestyle, you're gonna go back to the same lifestyle that you had before, you're gonna gain some of that weight back. And then there's a cycle and a cycle. So what we're trying to do is not just give you the drug, but also to support your lifestyle and support your health by going through a weight management program and putting a weight management program to it. and then give them the support.

Well, and just doing the math in my head, and as I say, it would be like if you didn't want to jump through the hoops, you'd basically, give or take, pay about $1,000 extra a year. As I say, just doing rough math, so I think ultimately you could, if you're willing to do it, you could save some money, but for those not willing to do it, it'd just be a little, it'd cost a little bit more, which, I mean, it wouldn't cost any more than it does now, so I, Yeah. I'll be interested to see more about it, but I think that's probably not a bad direction to go.

You'll get more information around in October. Okay. Yeah.

And we'll see, as you said, it's developing next. You're talking about a pill form, which is going to be cheaper. We'll see.

The market is changing every day. Yeah. All right.

Thank you.

Okay. Thank you, and I appreciate the comments about that. So the next slide we're going to talk about is fertility and menopause strategy. As you know, I think we added fertility a couple of years back, fertility support. What's wrong? But we offer fertilities for staff who is going through those situations. And so now we are offering more support around fertility and menopause. We are launching in January of 2027 more of a support personnel to go along with the fertilities. We're going to have 24, 27 virtual access to that. It's not going to cost us anything unless the people sign up. This will also help not only females, but males that are going through this situation with their spouses. It's called a family benefit. We're also offering menopause support as well, support for that. So this is going to be launching January 1, 2027. And that's more about what's going to be offered to them. Sit down. You'll see that in the Open Amendment booklet as well. Any questions about those two? That's it. So let me end this meeting. That because great people deserve great rewards, that's why we're here. Because all our people deserve great rewards.

Can we end the meeting? I would just have to sit here until you come.

If no committee has more questions, I think I will call the meeting. Thank you. Thank you, sir. I forgot. The next HOC meeting is November 23rd, 2026. Okay? All right. Thank you so much.