City Commission - Special Meeting

you you you you Thank you.

All right, one minute.

All right, it's 5 o'clock.

We're going to wait for Carmen. Everybody good to wait for Carmen?

Yes, sir.

I hear one, two, three, four, five. Holy, there he is. all right great all right all right madam madam clerk good to go mr attorney good to go mr mayor good to go colleagues on the commission good to go yes staff all righty all right all right good afternoon meeting date wednesday august 26 2026 at 5 p.m commission chambers 500 southwest 109 avenue roll call madam clerk thank you if everybody will please rise for the invocation Would anybody like to give the invocation? All right, let's bow our heads. Dear Heavenly Father, thank you for granting us the gift of life, the gift of family, the gift of friendship, most certainly the gift of freedom, and the gift of help. Please continue to bless those on this dais, our elected officials, our commissioners, our mayor, to make the necessary decisions for the betterment of our city. Please continue to bless our police officers, our firefighters, and the greatest military in the world. In Jesus' name, I will always pray. Amen. Please remain standing for the Pledge of Allegiance. Please be seated. Madam Clerk, public comments? None? Seeing none, item five, a resolution of the City Commission of the City of Sweetwater selecting employee benefits insurance policies for fiscal year 2026-2027, providing for authorization, providing for an effective date. Mayor Diaz, you have the floor.

Thank you, Mr. President. And we're here at this time of the year again looking at our benefits and looking especially at a health insurance company and seeing what the availability is and which company is the best. Let's just say the best for the employees and of this great city. Also, I would like, Mr. President, if we could do the following. If we could hear from each company in the sequential order they're in, and then questions for each company, why the person represents. from the commission and ask that company the particular questions that need to be asked. The next company come and that way I think we could get through and everybody could ask their questions or their wants after they describe what exactly they're proposing to the city and the cost. And then at the end, I guess I'll do a little summary. But after, I hear from our broker and also our HR person. And then it doesn't mean that tonight there's going to be a taking an action. It just means we'll get all the questions out of the way and we'll see where we go, as you and I discussed earlier.

Any objections to the Mayor's recommendations? Seeing no objections, the mayor still has the floor. Mr. Mayor, go ahead and call the first company. Which is the first company that's been lined up?

Bring them first. Let's go.

Hi, can you hear me? Yes. Yes, ma'am. Hi. Good afternoon. My name is Shara Schwartz. I'm with United Healthcare. Thank you for having me. I come today, you know, looking forward to continuing our partnership. that we have established starting October 1st of 2026. We were able to, at that time last year, able to offer a competitive proposal and offer some savings and continue to provide really top-valued benefits. What we were able to identify since then is that with our products and clinical services in place, we were able to continue to control costs and offer a very competitive renewal for you that is well underneath our annual trends, and to be honest with you, some other renewals that we also have open in our book of business. So with all of that in place and looking at the experience, meaning how well the claims are running so far, they are running very positive. We do have an immature amount of data. So since you're a newer client, we need to continue to gather more and more information to better identify trends and future spending. But with all of that in mind, we were able to provide with a plus 2.5% increase to remain on their renewing plans. And that also would include a program for the. Oh, I'm sorry. I'm short. I'm sorry. No, it's okay.

We just want to make sure we hear you clearly.

Our renewal also includes our UHC rewards premium program. What that program does is it allows the employees and the spouses the opportunity to earn $1,000 per year. And that would be by completing daily and one-time activity, healthy activities. So, again, it reinforces healthy decisions, healthy activities, and also allows members to earn money for their pocket. So if up to date, as of mid-August, I was able to pull a report, and so far your employees collectively have earned $35,000. So as we continue, hopefully, with our partnership with United, that is something we will continue. You guys have done a great job in promoting it. We're seeing the activity and the engagement, so that's something we can continue to do and offer as a nice value add. Also, some other programs that we do include, we have a lot of clinical options and also our vital pharmacy program that allows certain prescriptions to also be offered at a zero cost share. We have identified specific categories and they've evolved as we've implemented that program. So we're just continuously trying to allow transparency of the health care and great value adds to help for you guys as members do you have any questions commissioners I think this is a time to ask any questions in particular or any suggestions or whatever where you want to go any Commissioner wishing to speak Commissioner yeah you have the floor okay shooter stand by

I would like to know if any changes have been made in the medications because the copayments are not real for the medications. But I used to pay $30, I'm paying $87 as a copayment. That's what I want to know if we have been approved for.

Our prescription drug list, which we call a PDL for short, is updated three times a year, January 1st, May 1st, and September 1st. During all of those times, we have a committee that reevaluates all of the medications to find the most cost-effective and clinically proven base of evidence-based medicine to help provide options, and there is always a lower-cost option for every category. So the pharmacy is something we are constantly looking at. If there would be something specific of a scenario, we can always look at and evaluate on a one-on-one basis.

Any other commissioners have any questions before I say anything? Yes, sir. Commissioner Saldea is the other floor.

Yeah, did they have, did you guys have anything, I mean, I know there was an increase of 2.5%. Any changes that you guys are doing?

To the benefit themselves?

Yeah, to the benefits?

No, just a name plan change, just the name itself of the plan. But no, everything else will be remaining. There would not be anything taken away from the benefit.

Yeah, I know United is a good insurance. It's just that... the program or the package that you get. And the one we have is NHP, right? Is that the one we have? Correct. And then there's any other one besides NHP?

NHP is one of our products that we have within our portfolio.

Okay. But do you have another one other than NHP?

Yes. We have products that are under the UnitedHealthcare umbrella, UHC products.

And that's more expensive?

Yes. Yes, it would come with a higher cost.

And what would be the difference between that one and NHP?

The difference would be the network. NHP is specific to Florida.

Okay.

Yeah, I came a couple minutes after. The point being is NHP. Sure. Say your name for the record, please. Harry McDonald. uh specifically nhp and who are you harry mcdonald director of client management that's what we like to hear for the record excellent so the reason for the 2.5 increase is that we put a package together that typically would warrant trend but we wanted to partner with you we realize that you've gone through changes year after year we want to give you something that's sustainable and something that's going to be cost effective for you The NHP plan is ideal for your population. It covers all the people that are under your plan here in Florida. Why pay for more coverage outside of Florida?

Thank you. How many employees do we cover here in the city of Sweetwater?

Has it listed here?

215, I think it was.

Yeah, and the majority are using now the wellness budget. So each person has a $1,000 wellness budget aligned with them. and about half of the population is registered for that today.

Okay. I have a, you know, I'll give you a good example of my wife. She's, what do you call it? Diabetics. Diabetics. And to be able to get that medicine, I mean, she's going through hell. You've got to call the doctor and one of the commissioners also. Yes, I have to take me. And then we got the same doctors. And it's a headache just to get a medicine that used to be less headache than this one. You got to get an approval for the doctor. And then you got to call it in and going back and forth and back and forth. And it was not like it used to be. Because I remember when you guys came in, you guys tell us it was apples to apples. There was no apples. There was no apples or apples. It was apples and orange. Okay. So, you know, I have a little bit convenient on that because when, when you guys, when we got, when we choose you guys, it was apples to apples, like I said, but you know, and that's why I ask, did you guys are doing anything different than what you got? Cause I know there was an increase of 2.5%. Right.

So I think that this addresses the idea. Whenever you go from a change to a carrier to a carrier, you're disrupting all of the records, all the prior authorization that was in place. So you would have that same occurrence happen whenever you make a change again. When you're with someone and you stay consistently, you avoid all of that.

Okay.

And so those are the pains of making a change and a move.

Okay.

We're building good momentum. We would hate to disrupt it again to send you back through that cycle.

True. I mean, I'm going to agree with you on that. Thank you.

All right. Pleasure. Commissioner Esu, do you mind if I say something before you? You know what? Go ahead. Go ahead. Go ahead.

I'm gonna mention it and then you go ahead. Go ahead, go ahead. So United, I can't be any happier with you guys. I'm just, I have to make it public. I'm just a father of a newborn, a week old. Everything was so small with United. We have little gaps when it comes to the monitors for the diabetes. I don't know how you call the diabetes older than 40, whatever, something, diabetes. And we have itches with the monitors, stuff like that, but you guys covered it. The program, awesome. I thought it was a scam. And to be honest with you, You do what the program tells you to do, and you get the Visa gift card right away. More than happy. My wife didn't use it. I used like $450, something like that, because I'm still waiting for that thing to connect, to do the steps, the night, that thing. And the money goes right away. That's something to have into consideration, because at the end of the day, it's $2,000. And it's a gift. You know what I'm saying? So what I want to tell you is that I can't be any happier with you guys.

Well, thank you so much, and congratulations to you. Thank you.

All right. Anybody else wish to say anything before I go? No? No? Okay. So it sucks that you guys are going to be the first ones because everybody else gets to cheat. What is the copayment for an ER visit? Ooh, everybody starts cheating and start making their notes. I know there's four people in this room that know the answers to that.

It is $100. Say again?

$100. $100. Make sure that they do that. And let me ask you a question and an urgent care.

Urgent care is on one plan, $20 and the other plan, $40. There's two plans.

I understand. Okay. Um, Outpatient surgery.

Outpatient surgery will be for one, the first plan, deductible and coinsurance, the second plan, $500.

I'm sorry, say it again slowly, speaking to my good ear.

The first plan for outpatient would be deductible and coinsurance. So that would be a 25, 250 deductible with 90% coinsurance. And the second plan for outpatient would be $500.

So for the employees outpatient is $500, correct?

For the second plan, that would be the employees, right?

We, we get a different plan than the employees, which I don't necessarily agree with. I think the employees should get the same plan. We get it by the way, if anybody wants to make that recommendation, I'm all for it. You're going to get a yes vote for me. Um, all right. Surgery and they got to stay in the hospital.

What's the deductible inpatient hospitalization on the first time would be deductible and co-insurance. And the second plan, which I believe you're focusing on is for $250.

So outpatient is $500, but if they're in the hospital, they only got to pay $250. Okay. Good.

Which is a great deal.

So that's awesome. My only issue is we are the stewards of the city, and there's a lot of employees that are very unhappy with you guys. Up here, we get to make decisions based on numbers and budgets and past experiences. This gentleman has a little bit of experience in insurance. Not too much, like 36 years. What does he know? So we obviously take advice and counsel. Those of us that have been sitting on this dais long enough

insurance for our employees has been a huge roller coaster so right now you guys are courting us like i'm a 16 year old and you're trying to ask me to the prom so why should we stay with you well i think what's important is that i think last year maybe more of a courting when you know we come in and present a proposal so what is fantastic is that proposal was properly priced of October of last year. And why we can see that is because our experience and how we're seeing the plan run and how the benefits are being utilized, it is, we are, it's in balance. So what that allows us to do is to continue to provide you with a very competitive renewal offer because we are seeing that we are already, as we have a little bit of foundation growing together of the data we have, as we get more, that will continue more and more. and we have been able to control costs between our medical programs, our clinical programs, some of our value adds as well, and our wellness initiatives that's allowed us to control the costs and continue to keep a very competitive renewal out there for you. We look for more of a partnership. We'd like to be seen as more a partner as opposed to a vendor that kind of comes in and out and can be flipped each event. So we want to continue that partnership because that's going to best allow us to help you.

I almost want to run you for office. So here's another question for you. Sure. People who are very dear, near and dear to me, who suffer from diabetes, well, in order for them to wake up the next day and not die, right, they got to take that insulin. And I'm hearing you guys aren't covering the insulin. I've heard this from commissioner his commissioner his wife who's by the way is the real commissioner this is just a facade commissioner who's my second wife my wife allows it we have a very open-minded questions asked she said oh you're like my son i go no no wife i'm your husband so what are you going to do to be able to court this commission when you have two individuals who are affected by you guys not covering insulin?

Yeah, I would just say that we find it shocking that insulin wouldn't be covered. Insulin is the most inexpensive. If it's moving to a GLP one or a diabetic specific drug for that, that's typically prior authorized because of the major expense. But it ends up being approved. But I get it. There's some hoops to jump through initially. Otherwise, everyone would go to the most expensive. But once that's settled and once you have a plan in place, you don't want to disrupt it. So the big reasons, you have all these individuals, half of the population that has wellness dollars now associated with them. Secondly, we're keeping your trend below the double digits. All of the increases that we're seeing, even some of our own and others, are double digits. We've managed that for you. We have the best in class discounts. No one else is going to beat that on price for us and for you. When it comes to diabetic management, we're the only one that I believe is offering the CGM, continuous glucose monitor, is embedded into the program. So there's a lot of big perks to make a change for something that can be very volatile for your population and for next year's increase.

I'm hearing you. She's still the politician that I want to run for office. You're doing OK. All right. But when I hear my colleagues talk about their personal experience with their lack of ability to acquire insulin. and I'm hearing what you're saying, two plus two kind of equals 17 there.

So another great, I don't mean to cut you off, I'm sorry. Go ahead. Another great component to the UnitedHealthcare products is also the UnitedHealthcare team that you do receive. We have a very dynamic team. Myself, I'm here in South Florida. We have someone else who's for, you know, we have someone who's in-house all the time doing service. If there is a very specific situation of an individual you know or you've already put time in with customer service or are kind of just hitting a roadblock, we are happy to engage, take that situation offline and look at it individually. We have the team and the resources to be able to do that because we don't want you to spend your entire day, we can't do it for every situation, but understand when something is very specific, something very important such as diabetic, insulin, things like that, there's always resources within the UnitedHealthcare team that we are able to help jump on call and help figure it out

for you we understand that it can be complex and overwhelming sometimes but we're happy to help yeah we have a dedicated team and we'll we'll absolutely look at each individual whether they're part of this group separate group we're going to look at those and bring resolution very quickly well if i were you too just in my closing i would be a little proactive and i'd speak to that fine lady right there and leave your information to get in contact with this gentleman and that fine lady over there Because I don't think you're going to be able to convince him unless you guys problem solve. That's just my advice to you, but what do I know? Does anybody else have anything else to say? Would you guys like a closing statement? Any commissioners? Yeah, Commissioner, I would like to have a question.

Yes, what do you guys have for an employee or for the city of Sweetwater for the cancer patients?

We have our cancer support network. In fact, we just renewed with our contract with the University of Miami. So we have those contracts specifically with Baptist, with University of Miami, and certainly across the country.

What about costs for the employee?

So costs should be contained in all the co-pays associated with today, and they're going to get the premier treatment from all the top facilities.

Okay. Thank you.

When a member does call the number in the back of their card, they're not just getting a customer service rep that might just kind of move them around or answer them. They're getting a representative that can see their true holistic view of everything that's going on in their account. So if there is a concern like cancer or something regarding prescriptions, things like that, that meant that representative really will be able to help and handhold them through the process and stay with them until resolution. And again, they engage our account management team locally. when needed, but again, if there's something specific, and we know a diagnosis such as cancer would be very specific and can be very confusing, we really encourage you to allow us to help. We're happy to jump in when we can.

Thank you. Thank you. Any other commissioners wishing to speak? Mr. Mayor, you have the floor.

Thank you. I want to ask Brown and Brown and Jolie, now at this time, any clarification on this incident, insulin issue, because I don't think it's pure insulin. I think it's what you were mentioning before. But I need to know what the claims are. If you would like to please come up a second between both teams. By the way, Brown and Brown is a broker, as you all know. And they handle several of our insurances. And Yoli obviously is handling our HR. And they deal with these claims all the time for you all. So I want to make sure we're clear. And at that point, to give them... By the way, I'm sorry I put you guys first. You should have been last. But... was to give me a chance now to rebuttal anything because what we want here is transparency and clearness and what benefits or approval or might be after this meeting but I want to understand very carefully last up president the commission you said this is very serious to us because some of these people have come it's not apples to apples as they see it anymore. It's very different than then they expected show with that. If you could see proof us.

Good evening, Council. Evelyn Alvarez. So regarding some of the issues that we've had regarding the GLP-1s, mostly has been because of the prior authorizations, and that's what we've encountered. It's not been necessarily that it hasn't been covered, but there is, we have to jump through hoops, right? We need to get the approval from the doctor so that the doctor provides the correct clinical to the insurance company so that they can go ahead and approve. Once we get through that, then everything is done and you don't have any issues moving forward. But unfortunately, the GLP-1s, and that's not just with UnitedHealthcare, that is with every carrier, it does require prior authorization.

Thank you for, I'm sorry. Thank you for clearing that. Thank you.

Just to add, when all of these changes were taking place at the beginning of the year and we were getting all of the phone calls from commissioners, from your spouses, from employees and their spouses, I don't know what I would have done without the help of the Brown and Brown team. They really were amazing. They called all of the doctor's offices. 10 million times if they needed to call to make sure that the proper paperwork was being sent to the united team so that then the authorization could could be processed um and i just want to say that i really couldn't have done it without them all right great uh so united would you like to make a closing statement or do they share to the here yeah just quick question

Hi, Yoli. Yoli, you know that the main issues that I think a lot of people has, it was the cost of the co-payment. You know, there was double. We're paying double for the co-payment of the mitigation. That's a fact. I mean, it's not like we're making it up. It's true.

I understand, and it's for many employees that have reached out to me to state that if they were paying before a certain amount, now every month or every three months when they pick up their medication, they're paying approximately double or close to double. And it's also not just for the medication. They're also paying more out of pocket for medical equipment. So to give you an example, a sleep apnea machine that before was covered did not have to pay a deposit or did not have such a high monthly rental fee. The monthly fee has doubled for medical equipment. So that's another factor and it's not just the medication.

Commissioner Saudis. I'm sorry, just because you, that on that point, is that with every company, the increase of what you just said?

the increase for the copays?

Yes, is that for all of these? Is that for every company that's doing that? Not only United, everybody increasing because of the?

What he's saying is every other company has had the same type of increases on their benefits. for medical equipment and drugs and so on. Is it across the industry or is it just particular?

Before you answer, I don't think that's for our people to answer. I think that's for this bid. If you guys agree. Now, if you want to ask, you can ask. I'm just giving you my opinion.

I mean, I mean. Not her.

I guess that's something that, Commissioner, if you don't mind, I think that's something that the representative could say in his closing statement. Okay. That's fair.

You don't want Yoli to say that. Yeah, that's fair. So, Mr. Mayor, Yoli and – Yeah, they're good until the next – United, would you like to give a closing argument?

So, well, thank you. I mean, we value the relationship with you. We believe that we're the best fit for you. for receiving a 2.5% increase is just not heard of in the industry, meaning because I would say this is the year of the provider, meaning that the providers in place today are getting their increases this year. We're keeping yours capped. If you jump for a quick couple dollars here or there, it's going to be a big, costly disruption factor for you. We're able to stabilize and give you the best package. What our co-pays are to be comparable to what the other plan offerings are Obviously, you can lower and increase copayments, but it affects your premium. This is something that you've had for a period of time with some adjustments to make it aggregate across the board. But our offer is to make sure that we're putting money into the employees' pockets, and that's the $1,000 per each plan year. That's going to make up for those copays.

Thank you so much, sir.

Thank you.

At this point, Mr. Mayor, who would you like to call up next?

Let's call up Admin.

have made i've heard of that those people i'm just following the way they're listed here yeah for the record the mayor is literally just reading off of a paper so go ahead hi hi how are you what's your name ma'am say your name for the record my name is lord is abraham um i am the manager of client management in um avmed and along with me i have our vp of sales and retention candy sickle I have our Director of Client Service and Sales, Lilliam Guzman.

Hello.

And our Director of Implementation, Raquel Honan, with me today. They are my lifeline. With that said, I wanted to thank all of you for first inviting us back. I mean, we definitely are very pleased to be here to be able to provide a proposal for you. As you've all known, we've serviced the city for over 20 years and we have valued the partnership that we've had with the city all this time. I believe the proposal that we went ahead and provided, it's a very comprehensive and competitive proposal for you. It has measurable savings for the city of about $130,000 annually. It has low cost share for your employee as far as their benefits are concerned. $20,000 in wellness funds that would support preventive and employee well-being. um also a renewal recap for next year as well so we don't have that of what's going to happen next year performance guarantees performance guarantees related to our implementation as well as our ongoing service for you guys you'll have the same local dedicated service team that you are all used to that you've been working with for so many years um live local bilingual member engagement representatives that your employees will be able to speak to direct access to our leadership team for whatever you will need and then um the experience of knowing the city for 20 years being a floridian based plan for over 50 and being in your backyard and by a couple of minutes away Do you have any questions?

No, I'm sure we do. I am sure you do, too, and I'm here to help. Any commissioners wishing to speak on this item? Yes, Commissioner. Commissioner Idania Iannou.

Yes, hi, Louris. Hi, how are you? My question is this, because I see that you have right here next to it, it says alternative 2.1. That's not the same that we used to have, is it?

I'm sorry, can you repeat that? I apologize.

Okay, right on the say AFMIC, it says alternate 2.1. Is that the same?

Oh, okay, I'm sorry. Can you tell me what that, I don't know what that alternate 2.1 is. It's the presentation where you modify the benefits. Okay, so our custom plan. Okay, perfect. Yes. So that is the custom plan that we did for the city. Yes.

Okay.

It is not identical, but it has a lot of and I can go over that if you would want me to go ahead. Okay, perfect. So as far as what it goes for the employees on that HMO plan, they're still going to have that $10 copay for primary care physician. they're still gonna have that $20 copay for their specialists where everything is covered, preventive services at no charge, retail clinic, many clinics at $10, urgent cares at $20. Now for their hospitalization, when they are admitted to the hospital, they will be subject to the deductible. The deductible is 500, but then there's no charge after that. So once they meet that one year, calendar year $500 deductible, your employees, if they have to be admitted at the hospital, will not have any other cost share out of their pocket, okay? So that's very important. Also, as far as their diagnostic, if they need to have an advanced imaging, an MRI, CT scan, PET scan, they're looking at a $200 copayment. Let me see what else. Routine labs are at no charge. And as far as the deductible is concerned, office visits, urgent care, emergency room, outpatient surgery, prescription drugs, and outpatient diagnostic tests and rehabs are not subject to the deductible. So there would be no concern for a member having to meet the $500 deductible for that. It is really based on the admission to the hospital for home health care, general medical equipment, and hospice services.

Any other commission wishing to speak on this item? Speak to admin?

Yes. Commissioner Saladius? Yes. Yeah, what's the difference between this package that you're bringing to us now and the one that we have before?

Okay, so there's a couple of planned differences. So, for example, the one that you had before, you had a 10% coinsurance after a $250 deductible for that hospital admission. In other words, it was open 10%. of the contracted rate. At this point is $500 admission, I'm sorry, deductible, but then no charge after that $500. So the members, if they were to have to be admitted in the hospital, they're really looking at a one time $500 deductible. So that's one of the major changes. Your advanced imaging, MRI, CT scans, PET scans, before you had to meet that deductible and pay 10%, again, an unknown number, whatever is the contractor rate. Now they're looking at a $200 cost at an independent facility. So there's no guessing game of what they're gonna meet the deductible as well as that coinsurance amount. So those are the major enhancements. Some of the changes, like I mentioned, the deductible did go up to 500 before it was 250, but again, it was 250 plus 10% coinsurance. Now it's $500, no charge after, okay? And then emergency room did change, went from $100 to $250. And what's the reason for that, right? You definitely wanna encourage your employees to go to an urgent care center when it's not a life-threatening situation, to go to a retail clinic when it's not a life-threatening situation. If everyone were to jump in, if the emergency room is such a low cost, $100, very similar to what an urgent care is, people are gonna be jumping into an emergency room

Yes. Mr. President. Mr. Mayor. Thank you. I just want to make sure because I think I heard it two different ways. Is it $250 or $100 for an emergency visit?

The emergency room is $250. It was $100 before.

Okay. So now if the person goes on any emergency.

Emergency room.

It's $250.

Absolutely. Yes.

Okay. And if it results into them being admitted?

then that $250 is waived, and they will be responsible if they have not met.

For the $500.

Right, but if they had already met the $500 deductible, then there's no charge.

Okay, thank you. That's $500 through the whole year?

Calendar year deductible. Calendar year deductible. Absolutely, yes. Starting January 1st through December 31st.

Any other commissioners? Sure. Commissioner Isidro Ruiz. Hi, Lord. Yes.

Hi, I'm doing great. Thank you.

I'm going back to my pregnancy period. Okay. I'm still processing.

Okay. Absolutely. And congratulations. It's been a week.

So is it a boy or a girl? It's a girl. Daddy's little girl. I'm dying to go back.

I'm sure.

Ultrasounds, $200.

Ultrasounds, it is, no. Oh, I'm sorry, what?

You just mentioned it right now. You said diagnostics were $2.

I said MRI, CT scans, high-end diagnostic tests. Not ultrasounds. Right, so x-rays and sonograms fall under our diagnostic test, and that's $75.

$75, after you made the deductible.

No deductible. The deductible does not apply to that, no.

Perfect. That's one question. The second question is... Most drugs covered. Does that include weight loss?

Weight loss medication? No, it's not covered. Not for weight loss.

Fertility drugs.

Well, right. Diabetic, but not for weight loss. However, because we do have the $20,000 wellness fund, we can use that to provide services through other vendors that we can work with that would provide discounts for those type of weight loss drugs for bariatric and others. So there's things that we can do with that.

So we're going to go with Manjaro instead of weight loss, fertility, erectile dysfunction. No COVID.

That's not covered. That's not covered either.

It's just supervision.

But the same, we can work with a company that does discounts and use that wellness fund for that type of...

All right, service.

Commissioner Saldias. Yeah, what about the GLP-1 patients? That's .

If it's for diabetic, that's totally different. That is covered. If it is for weight loss, then it's not.

Yeah, but it has to go through the doctors, through the whole process and the whole thing, right?

Yeah. So there is, um, you diabetic, I'm talking about the diabetic diabetics for the Manjaros, for the GLP ones. You do need a, um, an authorization, however, and if it's already in place, we, and, um, we work with the members and your, and your team to make sure that we do a full transition of care. Our medical team will work with the providers to get the necessary documents. Um, they get the first 60 days. to make sure that the transition goes smoothly so that we have time to do all the back work to get the required authorizations in place.

Thank you. Does any other commissioner wish to speak on this item?

Sure.

Commissioner Reynold-Bure. Just a quick question. Yes. For the vision and dental?

That's not through us.

That won't be through them because I see only three of them here. How would we get vision and dental? Yes, so we would have to go either with United, Florida Blue. If we were to go with Ahmed, I'd say, we would have to choose one of these three.

Okay, so I'm sorry, through the chair. Hold on, let him finish.

Yeah, no, no, I just saw that, you know, United Health has, here, I've met, didn't have color-coordinated. Guardian, I'm guessing, is curative, or? No. No, it's just separately? Okay, just going through the colors, I thought it was the same thing. Okay, no, it was just a question I had.

That's it, no questions for me? Commissioner Isidro Ruiz.

So, Jolly. You don't have to fill it up. So basically, UnitedHealthcare is providing medical, dental, and vision. Correct. And that's the only out of the four of them that is provided the three services, right? Thank you.

All right, so if nobody else has any questions, I'm going to ask a few questions. Go ahead. Commissioner Baiciu, you have anything? No. Still processing, all right. So I'm going to ask the question, why'd you break up with us?

Why did we break up with you? Why did you break up with me? That's a different story.

You know, I'm glad you asked. You're right, we did break up with you. Because you gave us a 35% increase. So, I'm going to ask you several questions. And I think you know my style. I'm not afraid to ask the tough questions because our job is to be the advocates for our employees. And if we don't fight for our employees, then... So, the first question, before you answer that one, this fine gentleman said if we... If we change, it's going to be a big arroz con mango, and it's going to disrupt things. So how would you respond to that to us? Not to him, to us.

This would be the third time that you guys left us and came back to us, and I think it's been a very smooth transition.

Very toxic, very toxic relationship.

Yeah, very toxic. It has been a very smooth transition both times that you guys came back to us. We have enough time because we're starting this so early where we will be able to make sure that everything has been implemented correctly. That's where we have our expert, our implementation director, Raquel to walk through the entire process. We will have our medical management team as well as our pharmacy team in order to get the information from your employees that do have any pre-existing conditions or treatments that are going on and prescriptions so we can get that ahead of the game. And you have us. I mean, you know exactly who to call, where to go to. We're literally not even 10 minutes away from here that we would be able to.

So my next question is, Why did you guys give us a 35% increase and force our hand in firing?

So unfortunately, it was based upon the experience the city had at the moment. So while the current carrier that you have now has gotten, your experience has gotten much better throughout this entire year. When it was with us, your group was running a little bit much higher than what it is today, so.

Well, it wasn't the carrier that did it, it's that young lady sitting right there that did it.

Well, we would have to actually look at the data, but you may have had a high cost claimant that is no longer have that that same diagnosis, or maybe that person is no longer with the city, it could be or more than one person.

So what you're saying is the 56% reduction that Yoli did with our employees. Now we're more enticing and it's better for you to bid now because we're not so toxic. Is that accurate?

Is that too direct?

No, so that's not. So basically, the pricing is based on the group's overall pool, right? So depending on what you spend and what we are charging, that's where the cost comes in.

Sure.

Over the years, we have always been pretty conservative, and we maintain our renewals at a fairly... stable rate, which is why you guys have renewed with us over the years. What happened in, I think it was the last year and maybe the year prior, the overall risk of the group got a little worse, and I would have to go back and look and see who it was and what happened exactly, but because that risk got a little higher, we had to provide higher increases to kind of hopefully stabilize the rate again. Since then, your overall experience has improved, so we are able to come back and provide that stable rate that we would have had had you guys stayed with us, we would've been able to stabilize that rate back to, based on your experience.

Well, if you would've hired Yoli, you probably could've done that. We love Yoli. So, yeah, she's all right. So I was a big advocate of admin. because I've been with the city a little while, two years. And it's most certainly been a roller coaster ride with the ups and downs. So within your final statement, unless anybody else has any questions, I'm just gonna ask one more question. Why should we stay with you and what is going to stop you guys from raising the rates back to the reason why we terminated you and what could you do to help us to make sure that never happens again?

Mr. President, before they answer that, let's be fair and let the Brown and Brown and Jody come up a second. Well, hold on, hold on. Before that.

Hold on, hold on, hold on. I want my question answered.

Oh, because the other guy did it after them. That's why I.

That's okay. Go ahead.

All right.

Go ahead.

Okay. Sorry. I got sidetracked. Would you mind repeating the question? Where do babies come from? Sorry.

What is going to preclude you from raising our rates again? What are you going to do to help us ensure that you can help our employees not have the exposures that we had before? What can you help our organization do to make sure that our employees don't have that exposure, and why should we stay with you?

Well, first of all, we are providing a rate guarantee for you for next year. So renewal rate guarantee, again, dependent on how the group is performing. So that is one of the ways while we'll be able to go ahead and provide you rate stabilization depending and not a higher increase, again, based on the experience of your group. Again, we're here, we're local. We will provide the services that your employees will need. They'll be able to access, they'll be able to have everything that they've had so far for the last 20 years, the experience that they've had with us, and we are, you know.

Let me add a couple things. Yeah. So to add to Lourdes's, the rate guarantee is really in place because first year back, UHC said, it'll be in, in, um, uncredible, you know, it'll be early on first year back. We'll be looking at, um, the overall experience. So therefore we're putting in a rate guarantee. So, you know, we're not going to just bulldoze you back with a, with a high increase. The other thing that we have is that we have our reporting system now has more data and more analytics that we can share so we can start tracking and we can come out quarterly or monthly depending on the need and really talk through what the trends are and what we're seeing happening within the city itself and put things in places that'll help us to maintain and stabilize the overall experience of the group. Does that help?

Yes. Thank you very much. Mr. Mayor, you wanted to call Yoli to do what?

Thank you. Yoli and Brown. And Brown, please.

Thank you very much. You're welcome.

If you have anything after we have a question, you can come up. You know, I, I've been around the industry a little bit and, and as the president said earlier, when a rate guarantee is a rate guarantee, it is stated, um, so much a year and it doesn't go up for the two years. Now there's variations to that rate guarantee. Could you please explain the variations?

So the variations from avid is based off what they said, the minimum loss ratio. So which is the experience of the group and how you're running. So if you're running below 70%, they're guaranteeing no more than a 5.5% increase for next year. If it's running less than 85%, maximum increase is seven. And if it's between 85 to 95, 12%, and anything above 95%, there is increase of 18%. Greater than 101, there is no guarantee in place.

I wanted to get that clear because that's not really, in my eyes, a reg guarantee. That's a schedule of subida, or increase. I want to make sure that's clear because when you say reg guarantee, first thing that comes to our mind, solid rate for a period of X amount of time. So I understand that's just a procedure thing that is done now in the industry, but I wanted to get that clear. The other thing is, basically, The 500, and by the way, let me be real clear. Every single company that is here is an incredibly good company. Everybody's good, the employees are great, everybody's trying to get things done, and we hopefully benefit as the employees of the city for whichever company will end up finally with us. The issue that I want to make clear is the $500 whether it's $100 or $200 when you get in, you still gotta meet your $500 deductible. And the co-payments, they level at the $10 or $20, depending on who it is, until you meet whatever the 500, or no, they stay like that forever. End of year of service that we're contracted with.

The deductible only applies for the hospitalization.

Come up to the microphone, please. Got a lot of people watching on TV.

Apologies. So the hospitalization, the deductible only applies to where there's a hospitalization and a couple other services that then, once the deductible applies, there's no charge after that. No, I understood that.

I'm sorry, maybe I misstated myself. The copayment of the $10 or $20, I thought it was clear, but that $10 or $20 payment, how long would that last for? All the time throughout the period of time? They say, Vanya has to see a doctor, whatever, X amount a week.

To the maximum out-of-pocket, which is $3,500. $3,500.

$3,500. $3,500. Okay.

Mayor, I'm sorry. You're saying $10, but can you clarify for me which $10 copay are you referring to?

They mentioned $10 and $20 of copay.

The mayor said for the primary care, it's $10 visit. So the copay for primary is $25, and the specialist is $50.

No, it's $10.

That was my confusion. This is why I wanted to ask.

Sorry, 10 for PCP, 20 for specials. Here, SBC. 10, 20.

Those are the revised.

This is from the revised where the? The second. The second version?

Yeah. Yeah, that is the custom plan.

Okay, so the original proposal came at $25 copay for the PCP and it's been revised to now $10 for the PCP. There's one more thing that I wanted to mention on the AVMED plan. The network for the employee plan is a tri-county network so it's miami broward palm beach it's not all of florida the upgraded plan which is the ppo plan that employees can choose to buy up if they want to or that one is offered to the directors and to elected officials that one is a florida and national network But the employee plan is a tri-county plan. So that is a big difference from the plan that we have now and the plan that we had before with admin.

Jolie, then on that plan, if an employee is visiting a family member in Jacksonville, somehow or another, there's an accident. They have to go to the emergency room because nobody goes somewhere just to get hospitalized for something. It becomes an emergency. What would be the out-of-pocket for that particular employee if they're not in the PPO plan?

$250. Right. It's $250 because all emergencies are covered under this plan.

But if they haven't met their $500 deductible?

That's a copay. It doesn't apply. So think of the deductible as something really big, like a big surgery, something catastrophic. But your copay for an ER is just that. It's a copay. The deductible doesn't apply yet.

Are we 100% sure of this? Okay. All right.

All right. Thank you. Would Abbott like to make a closing statement?

I'd just like to clarify that for those... that are traveling outside of our network. Um, on the aim, the tri county, they still, they would also have virtual care visits. They would also have urgent care, retail and prescriptions outside of our tri county. So it's not just emergencies.

Okay. So they lose a pair of glasses. They need to get a new pair. It'll work outside. Oh, that's right. They don't. They don't do they're on the outside. Yes. Sorry. All right. Well, you mentioned it.

So one last question to have med. If you guys can step up to the microphone. One last question for you guys. If one of our employees is visiting Washington, DC, and they have an emergency visit for kidney stones, what happens?

They have the same access as anywhere in Florida.

So how much is that going to cost?

It'll be $250 for the emergency room, no charge after that, unless they're getting admitted. And then if they're admitted, it'll go to $500 deductible, ER wage, no charge after that.

Okay. All right. Does anybody else have any other questions? Do you need a closing statement?

Sure. We'd love to partner with the city again. We're excited about the years of service that we've had with you and looking forward to another year and many more to come and being your partners.

Thank you very much. Stick around. We may have some more questions. Mr. Mayor, what's next? Curative?

Yes, sir.

All right. Step right up.

Good evening, hi.

You're the next contestant on The Price is Right.

I know, I'm a little nervous. Hi, my name's Stacy Granger, and I'm the VP of Sales at Curative, and nice to meet you all, and thank you. We're very happy to be amongst the company here, and I know it's such an important decision. So Curative, we are the new kids on the block, so to speak, but we have been offering health insurance for the last four years, two years here in Florida. The company is AM Best, A minus rating. And what's really nice and unique about Curative is we actually believe that better healthcare and better health for your employees comes by removing the financial barriers that are just, I guess, have become the norm on health plans. So we have very intentionally designed our plans, whether it's the EPO plan, the most affordable of the three options, the PPO or the PPO Max, that all of our members have the option of using in-network care at a zero copayment, zero deductible. So our plan designs, even preferred prescriptions, are going to be set up so that members will have a zero copayment, zero deductible when they access care within Curative's network. So it definitely makes people breathe a bit of sigh of relief, you know, that they are not worried about If I go for a preventative screening, is this going to become diagnostic when I go for my colonoscopy and they remove a polyp or a woman, we need to go and have our ultrasound along with our mammogram and the ultrasound is diagnostic. You really have that clear line of sight as to what your budget is for your healthcare expenses throughout the plan year with Curative. We do ask our members to do one thing, and really it's about getting engaged and being accountable for your own health, and we wanna meet, Curative does, we wanna meet with all of our members that are age 18 or over during the first 120 days that they're with Curative. to do what we call a baseline visit and when people hear a baseline visit they think this is going to be a really big task or you know you're going to have to schlep somewhere and go for services but really what we're asking our folks to do is once you come on board with it you'll receive a welcome email from us we ask you to go online and schedule time for a zoom call so each person can schedule their zoom call at a time that's convenient to them we ask that they do that within the first 120 days and i want to be really clear everybody from day one through 120 whether they've done their baseline visit or they're in process of doing it they enjoy the zero co-payment zero deductible benefits throughout that 120 day period But folks complete their baseline visit. It's an online conversation. And we do it for really a couple of reasons. First and foremost, we want to welcome folks on board with Curative. And we want to make sure that our members have the opportunity to meet with someone that is very near and dear to our hearts, which has a role called Care Navigator. And the Care Navigators are there to answer questions that the member may have on an individual basis. and we meet with the dependents that are over age 18, as well as the employee that is over age 18, because sometimes it's the spouse that might be the one that handles the health insurance, and they have all the questions or have the health condition that might be going on. So we do take the opportunity to meet with all of our members that are age 18 or over, and that Zoom call can be done on a tablet, it can be done on a phone, It can be done on someone's computer. And we can do it in English and Spanish as well as in other languages using a language line. But we're extremely well versed. We launched in Texas. We're here in Florida. We're very well versed in doing our baseline visits and supporting our members in both English and Spanish. So the goal of that conversation is to welcome and onboard the member, answer their questions, make sure they understand how to find a doctor, make sure if there's a prescription that they have questions about. They've got an upcoming surgery, how do I help coordinate that? The care navigator's there to really give them an overview of benefits and answer their questions. The Care Navigator maybe spends that Zoom call probably between 40 minutes to an hour. The first 20 minutes or so is with the Care Navigator, and then they'll hand it off to a clinician. And we want folks to have an opportunity to speak with a clinician. And the reason behind that is really we're not looking to become someone's doctor. We know people have their personal relationships with their doctors and their healthcare professionals. but what we're looking to do is to make sure folks are aware of all of the services that are available to them based upon their health history, their family history, their own personal healthcare journey, and we're looking for any gaps in care. We meet with many people and we probably say that the folks fall into three different categories. You have folks that come on board with us, They're pretty much, they take their medication as prescribed, they've got doctor relationships, and they're doing pretty well. The baseline visit, they don't really get a lot of recommendations, because they've got things under control, but we certainly spend time with them to answer their questions. Then you have some folks that maybe have not engaged in their healthcare in a bit. They've put things off, they know that they should be taking a medication, but they haven't because it's expensive, or they have not found a primary care type doctor or a gynecologist or a doctor that they like and they've put off going to the doctor, could have been because of expense as well. But we want to reengage that person, help them maybe find someone within network and get them kind of back thinking about how do I live, you know, take best care of myself. And then we have folks that we meet with during the baseline visit. And we're not looking to exclude anyone, please. I have to say that right off the bat. But they do have really complex medical needs. And we, unlike many carriers, we want to be proactive about that and help those folks with clinical care support if they do have a complex medical need from the onset. So we find out a little bit earlier on other folks may find out after you know, another carrier might find out after somebody who's had a hospital stay, but we're looking to try and engage with our folks early on in their tenure with curative. So baseline visit is really a key component to continue the zero copayment zero deductible benefits throughout the entire plan year for our members. We get 98% of our members to do the baseline visit and I have had groups that have had 100% compliance with the baseline visit. Full disclosure though, the hardest people to get to do the baseline visit are your dependents that are 18 through like 26 and 30 that are on your plan because they're college age kids and they're busy and so mom and dad need to give a nudge there. but we do the tracking of who's completed their baseline visit, who has scheduled their baseline visit, and who has procrastinated, and Curative will send out up to 20 reminders if somebody waits to day 19, 119, to do their baseline visit. We don't ask you all, you're busy running the city, to do tracking for that, but we will send out the reminders. You, though, will have a line of sight as to how people are progressing. amongst your team to know where people are. And the team at Brown and Brown and Yoli will have access as well to be able to see the progress through the baseline visit. I'm going to pause there for a second and just breathe.

Would you like some water?

Yeah. No, I'm good. Thank you so much. So we offer three different levels of plan design. We have the EPO plan. The plan is designed so that it's all in network. We have a PPO plan, and then we have a plan called the PPO Max. And really the main difference between the plans is that the out-of-network benefit will vary. but the in-network benefits will be zero copayment, zero deductible, free look for the first 120 days, complete your baseline visit, and then for the entire plan year, you're set up with that zero copayment, zero deductible benefits for that plan year. At renewal time, we will actually do an abbreviated baseline visit where we do a check-in with our members, we provide education resources, and then there is a clinical check-in, because things can change very VASTLY FOR SOMEONE OVER THE YEAR, SO WE WANT TO MAKE SURE THAT THEY'RE GETTING THE SUPPORT THAT THEY NEED. ON THE THREE PLANS, WHETHER IT'S THE EPO, THE PPO OR THE PPO MAX, EVERYONE WILL HAVE ACCESS TO A NATIONAL NETWORK. curative has done direct contracting with providers and we're continuing full steam ahead to contract with providers so we have our own direct network and then we have something called the cash card eligible providers that are part of the access point for our members using credit card that we give each member called the curative cash card and I'll do a deep dive into that but I just want to mention that all of the plans will have a national network so if you're traveling if you've got kids that go to school out of state we actually partnered with Cigna to use their PPO network outside of Florida Texas and Georgia where curative is really very strongly building our own networks I'm going to talk about the Curative Cash Card and how we have our network. So just to give you some frame of reference, all of our members receive an ID card from us. When you get your first ID card from us, you get it online if you like, but you also receive a physical one. And you also receive from Curative something called the Curative Cash Card. And this is a very novel approach, but it really does help us with giving our members some flexibility to nominate providers. And also as we continue to work on contracts with different providers here in our local area and throughout the state and also nationally. It helps us to allow our members access to providers that You find on our provider search that show us curative cash card eligible providers. So if you happen to go out on the curative network, you're going to see that we have a lot of direct contracts. And just to give you some examples, here in Miami-Dade County, we have University of Miami directly contracted with us. We have Nicholas Children's and Jackson Memorial. Up in Broward, it's Cleveland Clinic, Holy Cross, Broward Health. But Baptist, for example, we have them designated as a curative cash card provider. Our members can still use Baptist and enjoy the zero copayments, zero deductibles, but the payment method is different. Our members would pay using curative's credit card that each member that's 18 or over will have possession of. It will be in the member's name, and they are an authorized user of the card that curative holds. It does not affect the member's credit. And just how does that card work? That's usually a really big question because it seems a little outside the box thinking. But if you're going for a simple office visit, the card is really set up so that you should be able to just use the card and swipe it as long as that provider is listed on our website as being a curative cash card provider. You don't need to call curative. The dollar amount is reasonable, and it's going to go through easily. If you are planning a surgery, a hospital stay, similar to what would happen today with any of the carriers that are here today, there is a need to get in contact with Curative. We would ask that you get the good faith estimate from the provider. If the provider is a cash card provider, they will give you a good faith estimate because you're going to tell them I'm going to be paying with cash using the curative cash card. And when you pay using the card, you're just asking, hey, I'm going to pay the cash price. They can give you the good faith estimate. And then our member services team is able to make sure that the member, that we approve the services, that member has the funds that are necessary to go ahead and pay. And oftentimes, members will pay online. For example, with Baptist, they pay using the Pine app. Some other providers use MyChart, but there is an ability to also access those providers that are designated as curative cash card providers. So when you look in our website, you're gonna see providers that are listed as directly contracted, they'll have a gray dot, and you'll have others that are gonna be listed with an orange dot. Our members can access either of those, but the path to accessing care is just a little bit different, and the cash card being the non-traditional. For lab work, like LabCorp and Quest are both contracted with curative, so you use your traditional insurance card. You would not need to use the curative cash card. You can use the curative cash card, though, at any urgent care. And again, members that have completed their baseline visit have the zero copayment, zero deductible benefits. i need to pause and tell you that if the members are part of the two percent that don't do their baseline visit sadly i'm completely avoidable they will have a five thousand dollar deductible the plan will still be very comprehensive and cover eighty percent but the member would incur that five thousand dollar deductible beginning on day 121 for the remainder of the plan year and they kind of can't get out of that i guess doghouse situation until the next year when they do their baseline visit But I promise you that no one will be surprised that they needed to do the baseline visit. And what we often hear is, you know, a few folks start doing the baseline visit and they tell two friends and people just get really comfortable with the idea that this was a really good opportunity for me to engage in my healthcare and have a conversation and learn a lot about how to use the plan. We will cover with the member how to use the cash card, how to look up doctors and such during that baseline visit. I don't know if I have a time limit, but.

You don't, go ahead. Okay.

All right, you can give me the rude lights or something if I do, so thank you. Prescription drugs, always that seemed to be very much the hot topic, and it always is the hot topic. I'd like to say that you are unique, but you are unique but not necessarily in the fact that prescription drugs are very important and really touch everybody's lives. So we have an interesting approach to prescription drugs here at Curative. We have a very custom formulary and we have very intentionally designed our formulary so that 98% of what our members will take will be a zero co-payment. It's not 100% and we do have a formulary list. So there are drugs that are going to be on the list. There's gonna be drugs that are not on the list. If the drug is on the list and it's in the tier one, it's going to be a zero copayment. The only time for in-network services that Curative actually does show some copayments for a member is going to be the $50 copayment for a non-preferred drug, and then $250 for a non-preferred specialty drug. But within that tier one category, there are specialty drugs. There are name brand drugs, there's generic drugs, And then we will lean in and put on our formulary in the tier one category, the biosimilar specialty drug whenever possible. And that is really to be able to be a good steward of everyone's money here and use effective drugs that have a huge cost differential. So we do have a biosimilar first strategy for putting drugs into the formulary list. If a drug is not on the formulary list, there is an exception process. It's not an easy yes to any non-formulary drugs. Quite frankly, we would want to see if the member has tried some of the formulary alternatives that are available to them and had an unsuccessful outcome. before we would consider approving a non-formulary medication. And our formulary list is out there on the website. We've done some studies with the Brown and Brown team already, and I think we had a really good overlap. And things like Ozempic, not for weight loss, are at a zero copayment under the plan. I'll pause.

You don't need to pause. You have the floor.

Go ahead. Okay. I guess I really want to ask you if you have questions, and I'll ask the Brenner Brown team if I just missed this.

Hold on a second, guys. So.

Yes.

First, we'd like you to finish, and then we'll open it up for questions.

All right, so just a few value adds under the plan. We offer our members that are age 50 or above the opportunity to take a test called the gallery test, and that is a cancer screening test. It screens for 50 different types of cancer with a single blood test, a very effective screening tool. We have caught folks with some things that would not have had symptoms or been caught under some of the more traditional screenings like pancreatic cancer, which does not have a lot of early indicators. It's usually caught very far down the path. So we offer our members the access to the gallery test if you're age 50 or above. Our members will have access to Wonder, which is a weight management application that many folks may be interested in if you do have a weight management goal for yourself, as we all do. pretty much too these days. And then really important to everyone, mental health. We have several great resources for our members. In addition, not solely virtual, but we have partnered with Better Health and Rula and two chairs. Our members have very good access to mental health support to keep them well. Mentally as well as the physical health Because we use that cash card one of the things that we allow our members to do is We take nominations on a regular basis if there's a provider that you don't see that is out on that you are currently seeing You've gone out on our website. You don't see that provider and you're interested in nominating them. We have a very easy nomination process for providers to be used and added using the cash card. So it takes us usually five business days. We review to see if the provider does things that make sense under a medical contract, under a health insurance contract. And there's an opportunity to go ahead and approve services with that provider. And we would then list them out on our directory showing as a curative cash card provider. and we often approach those same providers to get a regular comment.

All right, take a breath. Take a breath.

Okay.

So we're going to go ahead and give you plenty of time.

Okay.

All right? Commissioners wishing to speak on this item. Commissioner Saldizio. That was a lot.

Let me tell you something. This is, thank you, it was good. I mean, I have so many questions, you answered them all. Really? I mean, yes, yes. You guys came very, very aggressive. Your company is the first time I heard, I never heard about this company. Now, what city are they using this company?

So the city of South Miami has Curative here locally.

Are they the only one? Yeah. Okay. South Miami?

City of South Miami, correct.

Now, your zero doctor visit, zero pocket cost, I mean $260,000 saving for the city. I mean this is a minus 8.3% saving for the city. I'm speechless, you know, you did a very good job. I mean, I had a lot of answers, but you were going so fast, and questions, and your answer, I mean, that line that you were talking about, that you can talk to somebody, is that, I mean, you went over it very fast. Is that in Spanish and English?

Yeah, so we have our member services line is in both English and Spanish. They are available 24-7. We also have some really good AI tools that, you know, I know people either like or don't like AI, but we've got some really good ones that actually are super effective. but the member services line is English and Spanish. And then when folks schedule and complete their baseline visit, they could ask to do it in either English or Spanish. And if you do have someone, though, that uses another language, for example, let's say Creole, we are able to use a language line to accommodate that conversation so it's comfortable and can be done in whatever language the member says.

The other questions that I have is the based visit with 120 days on the 5K, Can you explain a little bit in slow motion on that?

Sure, absolutely. So members that come on board with Curative, regardless of which plan they select of the three options, on day one through 120, everyone for their in-network care and for preferred the tier one prescriptions, they are going to have zero copayment, zero deductible as long as they're staying in network. And staying in network means that you found that provider out on the provider search at curative.com, whether they be a provider that we list as a directly contracted provider, so curative has executed a contract with them, or a provider that we consider a curative cash card provider. So either way, you're accessing care at the zero copayment. If a member though does not do the baseline visit a member over age 18 doesn't do the baseline visit that Member would have a $5,000 deductible that would kick off on day 121 so the Member would have start with a $5,000 deductible we would not go back in and. re-adjudicate the claims that they had during the first 120 days, but sadly that person would have the $5,000 deductible. And I'm gonna give you an example if that's okay. Husband and wife and then they've got a child that's under age 18 and a child that's over age 18. So let's say the husband does his baseline visit, he is good to go, he's got the zero co-payments for the entire plan year. The wife does not do her baseline visit. Shame on her. The 120 days pass. She will have a $5,000 deductible. He will have 100% benefits. The child that's under age 18, because at least one parent did the baseline visit, then the child that's under age 18 is good to go. The child that's over age 18, it depends whether they do or do not do their baseline visit. Hopefully someone got to them and said, you need to do this, and then they will also enjoy the zero co-payment. Thank you. So it's on an individual basis that the punishment, I guess, or the stick would apply if that person did not do the baseline.

Thank you. Any other commissioners wish to speak? Commissioner Idaia on the other floor.

Yes. I have a question. No, go ahead. I'm a little concerned about the cash card, how it works. Yes. For instance, if I need to go to the hospital because I have an emergency. And the hospital, like Baptist, is the hospital that I go to all the time, and I know because I spoke to them already. They do accept the cash card, but they're not a provider. Not yet. Which is kind of weird to me because I found on your website that Dr. Hospital is a provider, and Dr. Hospital belongs to Baptist, which is kind of confusing, but maybe that's the way it is. But my main concern is this, if I have an emergency, I hope not. But I need to go to Baptist with a rescue or by myself or whatever. How do the cash card works? Because I don't want to have money there all the time. It's provided by the company.

Yeah, you're spot on. So if there's an emergency situation, whether the hospital is in network, a cash card provider in network or out of network, you would show your insurance card and they need to treat you. because they need to treat you. That's just how it is. They have to. And it wouldn't matter whether it's curative or any other carrier. The hospital needs to treat you. They would actually then bill curative and we would deal with it on the back end. But let's say a little different scenario. Let's say you're planning a procedure at Baptist. so you know it's not an emergency it's something you know that's going to be happening in the future what your provider would need to do is to provide you with a good faith estimate as to what they're doing um so we'll stay with baptist being the example here since they're creative cash card eligible they would say you know we're going to do this procedure and it's going to be x amount of dollars and And you would need to contact curative and your care navigation team or even our member services team, and they will make sure that it's something that can be authorized, that it makes sense from a medical necessity standpoint, similar to how today a prior authorization would work with a contracted provider, but we would do it through the cash card approval process. And then we're able to load the funds onto the cash card. really in any amount. So we have had many people who've had services at Baptist, and we've had to load the cash card in the tens of thousands of dollars for services. So it is a little different approach if you're scheduling something with a cash card provider.

So basically, the cash card is like, for instance, like if I'm going to do some procedure, which is something that you schedule ahead of time, how long would it take for the company to approve the money for the cash card so we can have the procedure to be done?

Sometimes it can be on one phone call. Other times it might take a couple of days. It really depends on the urgency and what level of procedure it is and what type of due diligence we want to know more about to be able to authorize it. But it's not a lengthy process. I've had people call in and get something authorized same day. I have other folks, you know, where it's something a little bit more planful and there's more moving parts, it may take a few days. And then if you're, you know, same thing would happen though if you're using a contracted provider that they would need to contact us for a prior authorization if you're having, let's say, a particular service as well. And we do try and steer our members to where it's gonna be cost effective whenever possible. We wanna keep costs down for our members as well. So we're trying to make sure that people are doing things that are medically appropriate and in a good place of care as well. Good question.

Any other commissioners wish to speak? Sure.

Commissioner Isidro Ruiz. Hi, ma'am. How are you?

Hi.

First of all, kudos to you guys, every single one of you. This is NASA to me. I'm not good at math. So what I've been looking at, so I'm familiar with every single one of you guys, not to kill you. Of course, it makes sense. So we are here trying to get the best coverage for the money, right? And at the same time, trying to get under those circumstances, so the best reliable company. We're making decision for like almost 200 employees, right?

Over 200.

And every single one of them has different conditions, situations. We have special education kids, we have cancer patients, we have diabetes. Like everybody else, like every single one of your customers, right? So when I look at Keto Youth, so I didn't do a research, I just went over it. And like you said, you're the underdog, right?

I'm sorry.

You said you are the underdog.

The only.

The underdog.

Oh, the underdog. No, I think I said that more than new kid on the block. No, but it's all right. It's all right. But we're probably the underdog too. Amongst these folks, yes.

Underdog companies under.

Or a disruptor.

Good leadership, which I believe you're a good leader.

They can control the market. Just giving the time. But really quick, I just went through a, And I found three little things that are really concerns. Which ones? A strict when it comes to meds, making members follow exact pre-authorization on pharmacy guidelines. Number two, a lot of complaints about extensive mental health care needs. Number three, trouble finding local in-network doctors. or may your pharmacist that accept the plan. I was looking through your pharmacies. Big pharmacies like CVS and Walgreens, everybody's used to it. And unfortunately, just the PPO max have access to CVS and Walgreens. So if I need a medication right now, I need to get my meds sent to a cuter pharmacy, which I have no clue what it is.

So I can address some of that.

So my question is, do you, based on your professional knowledge and skills, which I really believe you have, all these complaints from a bunch of customers are because you're like immature when it comes to business, relatively new? What do you think all these complaints are about?

I think when you go online and you read reviews for almost anything and you look at other carriers too, there's always something. Reviews tend to skew a little more negative than positive. I want to maybe address some of the things. Prescription drugs, prior authorization is definitely something that we have in place. We do have our formulary. We really want to keep costs down and managing the pharmacy costs really does make a lot of sense for both keeping premiums affordable, protecting that zero copayment type benefit for our members. So we do have a prior authorization process that's in place. For our members that are on the EPO, And PPO plan, the retail pharmacies here in Florida are going to be Publix and Walmart, yep. And then for the PPO Max plan, it does add CVS and Walgreens to the mix. Everyone would have access to mail order through Curative's pharmacy, which they do a great job. My husband is on four medications, including Repatha, which has to be refrigerated. It gets dropped off on our doorstep, and it works really well, so that's an option. And then we have a program in place for those emergency situations where a member might have something that happens in the middle of the night. You know how Publix is not open 24-7. So all of our members have access to something we call the Med Access Plan. and if there are very specific medications, it's certain antibiotics, EpiPen, it's a very specific list of medications that our members could go to any pharmacy. It's things that you would do once, you know, like it's because you went to the urgent care and you walked out with a prescription. You're able to go to any pharmacy to fill something through the med access plan, but it's very specific. It's not designed for the maintenance drug, but it does help with the concept that Publix is not open 24-7 for the members.

Don't you think that's a big hustle in order to get medications?

Do I think what?

Like it's a big hustle in order to get medications?

I don't know, I'm a Publix girl.

You mean hassle. I mean hassle, I'm sorry. I won't be able to get the medication from CVS or Walgreens if I really need it. I have to go to that process in order to get my meds.

What we would do is, in the beginning, we'd have our team help with going through the steps to explain how to transfer medications. It's really not that hard. If there is a Publix nearby, there's oftentimes a Publix across the street from a Publix. So Publix is very accessible and why we picked Publix. Publix also has great service. So our members have been very happy using the Publix, but we did save, truthfully, we're saving about 8% per fill by not using a Walgreens or CVS. So that is one other way that we are trying to control costs and be able to keep affordable premiums as well as the zero co-payments.

Good question. Thank you so much.

Any other commission wishing to speak on this item? All right, I have a few questions. I always like to let everybody speak first. So we gave you plenty of time to speak, and that was good. But then the longer you stayed up there, the more difficult questions were asked, and that was bad. So if anybody thinks that they got a leg up, you need more time, you let us know, we'll give you more time. We'll make sure we grill you like we grilled her. What is biosimilar? Never heard that word before.

Biosimilar is the same equivalent chemistry as a certain specialty medication. So it would be something that would be chemically similar where it could be swapped. up to the doctor's discretion, of course, but it really is, there's a huge difference in cost between the biosimilar and the...

There's my question. So if my doctor prescribes something, that's what my doctor wants to give me, your insurance plan is gonna say, no, you gotta take this biosimilar prescription. Is that accurate?

If it's one of the drugs that we don't cover, the specialty medication, and there is a biosimilar available for it, we would suggest the biosimilar medication.

Suggests one thing, requires another?

So we would suggest it because we would say we're not gonna cover it. If your doctor though protests and says there is a medical reason why you cannot use the biosimilar medication, and typically we're looking to see if you tried one of the biosimilars or an alternative if it's a non, let's say something that's not in biosimilar form, we would go through a, we would need medical information in order to authorize a drug that is not on the formulary list.

You guys would always want to recommend a generic drug just based on cost. Is that accurate?

Typically, yes.

Got it.

If it's available.

And then your gallery testing, is that a BRCA test?

It is not a BRCA test.

No?

No, it's really screening for certain markers for cancer.

Got it.

Different than, like, let's say genetic testing, which, you know, is an option, you know, depending on certain people will get genetic testing done. But the gallery test is really looking to see if there's certain markers that are early indications of cancer.

Got it. So you have, your business is, you guys have been in business for four years, two years out of state, two years in. Similar to Commissioner Ruiz, I also looked at your reviews. We all have good reviews and bad reviews. But when it comes to health care, I tend to want to pay attention. Curious question, you said your husband receives a certain medication, so is it safe to assume that you and your husband have curative insurance?

We do, yes, correct.

And you've had a phenomenal experience with cure. Never, not one negative instance with curative. Is that accurate?

We have had a phenomenal experience. So I came from having a high deductible health plan for many years where it was HSA compatible and we had some great years where we spent no money and we were younger and didn't have a lot of health conditions. And then I worked for Humana for 30 something years and that was the plan we had as employees. When Humana stopped selling health insurance, I came on board with Curative and I was really very excited about the idea that we were bringing something new to the market where people would have better affordability. And what I really felt was a tremendous relief was in my years with a high deductible health plan, there were many years where nothing happened and I was able to buy the kids braces using HSA funds, et cetera. But then I had some years where I was paying $6,000 out of pocket. So it's really nice to know as I've aged, my husband's aged, he's even a little older than me, that even if something happens, we're not going to have a big out-of-pocket cost.

Yeah. So just one thing. I usually follow my gut. My gut is usually right. And usually when something sounds too good to be true, it usually is. I see that your company's most certainly a disruptor. But maybe it's the new thing that keeps me from, I'm not big on price, I don't care how much it costs. I'm not gonna put a price tag on our employees, whether it costs, whether it's a $300,000 savings or we're paying $500,000 more a year, I could care less.

do you have a closing statement well before that any other commission mr mayor anybody want to speak commissioner i i just want to ask you uh are you a domestic company i mean you were raised in the state of florida to do business we were um we are admitted to do the um business in florida we're licensed to do business in florida the company though is um is based though out of austin texas And we are an A-minus, A-best rated company, and we have been for four years currently.

Yeah, you mentioned that. Commissioner Saladi is here before.

Yes, HR. I mean, did you guys check to see if this company have the, you know, they're in a network, they have their own doctors. Did you guys do a search with this company to see if they can, if I can use my doctor to them?

We did. And Brown and Brown helped us with that. They did what's called a disruption analysis. And they looked at the three companies that we're considering tonight to see how the doctors match and as well as prescription medication and pharmacy usage as well. So we looked at doctors and medications. And it was a very high match for both companies.

Both or all three?

Well, I'm not saying United Healthcare, because that's what we have now. So compared to what we have right now, the other two, it was a very high match in the high 90th percentile.

Okay, I was going to ask you the percentage, 90% match?

No, it was actually above.

Higher?

Yeah, it was in the high 90s.

Thank you.

You're welcome.

Any other commissioners wishing to speak? I'm sorry, ma'am. Probably you went through that part and I missed you somewhere. So the $0 in network price, you got to go to initial health checkup, right, within 120 days. You mentioned it or you didn't?

Yes, so you do what we call the baseline visit within the first 120 days, which is a Zoom call. So it's not going to a doctor or going somewhere. It's really from the privacy of your own home. You schedule your Zoom call, and you do it virtually, and probably 40 minutes to an hour of your time, depending on how many questions you have.

So if there is a pre-existing condition, does the $0 in there applies?

Absolutely. Yeah, it's not to exclude anyone from benefits. No one can bail the baseline visit. It's really about helping people along their wellness journey and getting people engaged in their health care and making sure they understand how to use the plan. Because to your point, we are a little bit unique. compared to maybe some of the other plans so it's an educational it's educational and then everyone does have the opportunity during the conversation about 20 minutes or so to speak with a clinician the clinician will tell the member you can share with me as much as you want or as little as you want but really they're looking to make sure that you're aware of what services are available to you there's some gaps in care you know someone that's over a certain age that hasn't done you know let's say a mammogram or a colonoscopy maybe they would want to do cola guard if they're not interested in doing a colonoscopy but really getting people thinking about their own health journey. And, you know, we all go to the doctor and you're, you know, you get a few minutes, you know, so it's like an unhurried conversation, which is really nice.

Thank you, ma'am. Any other commissions wish to speak on this item? All right, ma'am, you have a, you don't need a closing statement, do you? You said a lot.

I did say a lot, but I'll leave with telling you thank you so much. We really appreciate your careful consideration, and we hope we've given you some really good food for thought.

Thank you. Thank you, ma'am. All right.

Mr. Mayor, up next is Florida Blue. Is that correct? Okay, no. At this point, Jolie and Brown, come up a second.

We call that the mayoral curve ball.

What I want to make sure is, just like the other two, we ask also some questions. You know, there was a couple of things said that the commissioners rightfully had some good questions about, and we're not, this is kind of new to the process. When the company was mentioning navigators, okay, which is a person that they'll make the phone call to. Is this something that they will have that person available through their time with this company? For instance, if they're gonna go to Baptist as a commissioner, that was more of the question I think she was going to. At that point that she call her navigator, or the person that she deals with, and then just tells her what's going on. She's already has a relationship with her. And they can work through the process and make it a lot faster. At that point, is that the intent? I think that's what I was that is the intent.

You can call them or actually text them. Your health care navigator when you speak with them and do that baseline, they will give you their contact information and you can continue to call them or text.

And I believe Stacey mentioned that it's open 24-7, which is amazing, especially for employees who have an emergency in the middle of the night or something.

Any procedure that you have to have done, would you have to schedule? Is something that is going to be done at the moment going to be scheduled? Any outpatient procedure or surgery, whatever, you need to call the navigator to be approved?

If it's any planned procedure and, for example, an outpatient procedure, Obviously those are a little bit more costly. So as Stacey mentioned, you would get a good faith estimate. You would call your healthcare navigator. Sometimes it requires prior authorization, sometimes not. but they'll go ahead and load your card with whatever amount is due to them for that particular service.

But I have to go to the hospital first so they can give you the estimate, right?

Yes.

But just to be clear, any insurance that you have, you would have to get a pre-authorization, so you have to go through a process as well.

Because now we're talking about estimate. Before, you don't have to have estimate. You have to show your ID, so that's what I'm saying. So let's say... You have to go to the hospital first to give you the estimate?

Or actually, it should be your position that you should have a conversation with.

The only reason for the estimate is for those providers such as Baptist that require the cash card. If it's one of their direct access hospital systems, no.

No, I am clear on that. I just want to know how the procedure was. If it was my doctor, then my doctor would get involved and then I would talk to the navigator, right?

Right. It would be the same process as a pre-authorization process. The only difference is with curative, there's an extra step. If that provider only takes the cash card, you have to get that estimate and load those funds into the card. Okay.

Okay, and in that loading the card, there was also a question because we also heard some, look, there was also the other place that's with your insurance is the Coral Gables Police Department, if I'm not mistaken. Okay, it's South Miami and the Coral Gables Police Department. All the companies start somewhere, okay? So it's not like... You know, every company that's sitting there started at one point or another. So I understand. One of the key things about this, and I really want to get it across, and we'll go from there, but it's the ability to have the 100 percent coverage, which I think what Commissioner Diaz was getting to. But, yes, do I feel that it's going to take a process and it's going to take some time? I think that's That process with a card might be very difficult, maybe, to a point, but if they have the good navigator that they can navigate with, I don't know. That's just something that we'll look at. The older employees. She mentioned that pre-assisting and everything else was already taken into account. Was that part of, you know, they have some issues going on as we speak? Those issues will be picked up by this company, like any other company that's sitting in the audience.

Yes. However, I want to reemphasize regardless, anytime we have a carrier change, as you experienced with Ahmed going to United, any current medications that require prior authorizations, we will have to go through that process. Once again, all of those providers will have to be contacted by the member and have them submit the clinical paperwork to curative or to admin to get the prior authorization on file.

But just to, just to emphasize something, any employee right now that has a preexisting medical condition, if we were to make a move, they would still be covered under any of the new plans, even if they have a preexisting condition.

Correct. I just want to make it clear because I was something that was said to me earlier today. Um, We have a couple of older employees that are not under Medicare and they're under insurance. They are not affected in any way. Am I correct?

Correct.

I wanted to get that clarity here too. All right. This is, commissioners, sometimes one of the things that I see and the President said it very clearly, I see savings. I see some good savings. I see some not so good savings. I see some bracketing and some other companies that could put us in a bad place if there is not the best results like we had this year and in the future. they could jump up pretty high. And I think that was part of your questions, Mr. President, that you were asking. My issue is to find the best insurance that gets the best benefits and the best coverage to our employees, also to try to get a savings for the city if we can get a savings, but at least we give the best coverage for the amount of money that we're paying. i don't know right now i still have some questions that were developed by the questions you guys asked that we need to maybe ask the companies individually i don't think this is a proper form to negotiate uh i would rather do so and maybe i don't know what the scheduling is like for monday because i know we don't have much time correct uh to write this up and if if we don't stay with the company we're with, and we have to jump to one of the other two companies. And Mr. President, you asked a question about the Blues. The Blues were really a lot more expensive, and we didn't proceed with them based on the quality of the programs that we have before us. That was where we stopped.

The Florida Blue did not come to present? They're not here.

No. They're not here.

But we didn't invite them to come.

No, I don't think they were.

They were not invited.

Yeah, I don't think they were. I think the 8% kind of moved everybody. That was rude. More. Go ahead.

Through the chair. Commissioner Salda is on the floor. Yes, please, before it gets out of my mind. When you guys compare, I'm trying to get the word, compare this company that just came and the one, the NHB, What's the, is that apples to apples, or what do you guys see there? What, I mean, as experience, what do you see between this company, Curative, and the one we have right now? When you compare both of them, what will be your definition on that?

Okay, so for United Healthcare and NHP, you have a Florida network, and then the upgraded plan, you have a national network, whereas Curative, it's all a national network, so that's one big difference, right? Another big difference is obviously pricing, and I know that price is not a huge decision-making factor today because we're here for the benefit of the employees and we want the best plan for the employees, but it's a big deal, right? There's an increase of 2.5% versus a decrease of 8.3%. UnitedHealthcare offers $10,000 in wellness funds, which I happen to love because, obviously, HR, we love to implement wellness programs, and it's working because we have a 56% medical loss ratio in the claims, which is amazing.

Good job, Yoli.

Thank you. And the employees, when we met with UnitedHealthcare, they told us that our usage of the employee wellness app has been one of the highest that they've ever seen.

Awesome.

Wow. Which we've been chasing a lot of employees to get connected and get on the app, so I'm actually really proud of that. So that's something that Curative does not offer, right? This is money directly to the pockets of the employees in like wellness gift cards that they receive for participating in healthy activities. So that's something that Curative doesn't have. But in Curative's defense, they're offering a $50,000 transition credit of which I would love to take some of that and apply it towards wellness benefits so that we give back to the employees, right? What else? The biggest difference is that United Healthcare and NHP has out-of-pocket expenses for the employees, and Curative, if they complete that health assessment, they will not have any out-of-pocket expenses.

The only out-of-pocket expense that they will have is if they have the tier that it's a $50 copay or it's a specialty medication at $250 copay. Those are the two out-of-pockets within the curative plan. Other than that, if they completed their baseline visit, everything is zero.

On that point, one second. I know somebody had asked me the questions about the Epic Pen or something for diet and weight loss. I know one of the providers said that they're not covering it. Do you? Does Curative cover it or not?

So they all cover the GLP-1s for diabetes.

No, I'm talking for weight loss.

No.

None of them.

They do have the ability to add for weight loss. There's an additional rider, which means there's a higher premium. Okay. Which normally can run anywhere.

So you said that GLP-1, it's covered?

Like the Manjaros of the world?

It covered?

For diabetes for that baby.

Yeah. Does it cover?

Yes.

Yeah. Okay. Through the chair, commissioner. What about pre they have it?

No.

All right. Thank you so much.

Can I have just a quick question?

Go ahead.

I did check on my medications at the old there on the network. So, but that means that it's still, if we want to make any changes, we have to go to the approval even though it's there. Yes.

Okay. Yes.

All right.

Yeah. And madam clerk, um, Monday, I don't think we have anything scheduled.

Well, let, let, let me say something real quick. Mr. Mayor, if you don't mind, um, to my colleagues on the commission, what I'd like to recommend, um, we have three companies here, three, you know, good companies. You guys are obviously vying for our attention. Um, I would strongly suggest if you guys know the mayor, If the mayor can save a dollar, he will. I would strongly suggest that you guys change your bids and become more aggressive. There's not much time. I guarantee you he will negotiate the hell out of you. He's going to shake your pockets. And if you're not willing to negotiate, you're going to lose his attention. Just my advice to you. So you have the floor, Mr. Mayor.

Thank you, Mr. President. And I understand we have a At 6. What time. OK now I'm talking about in in the evening when the commissioners come. No all right so 5 o'clock us you guys be back here Monday. Money so we can make a decision on Monday.

Mister Rogers one more question has the police union. Been briefed on just the office. The union's over the store the rest.

The rep just which is who were forced to tell.

OK and what about the civilian Union.

The civilian union, I'm not sure. I think that's part of what we're gonna talk about.

Okay. Mr. President. Mr. Attorney. So if this matter is going to get continued until Monday, then it needs to be reset to a date certain by a motion and a vote.

Thank you, Mr. Attorney. Do we have a motion for a date certain? Commissioner, are you motioning or you want to speak? No, no, I want to speak something.

Commissioner Reynaldo Rey, you have the floor. So I wanted to make a recommendation to the mayor or Yoli. I Was looking at the plans for vision and dental There's one that's always come up. I'm sure the mayor knows about it because he worked for the county as well the vision plan I'm I met So if we could get probably a quote on that as well, give us a little more options to see what else we have in the network for ourselves. I mean, the dental seems kind of good. I've heard of Guardian, I know VSP and all that stuff, but if we could get a quote on IMED as well, so we could have more options.

All right, we had a motion by Commissioner Emanuel. Do we have a second? Second.

We have a second.

Do you need a roll call? We can just do all in favor say aye. All in favor say aye. Aye. Any opposed? Mr. Mayor, you have the floor.

No, I thought one of your commissioners was trying to get your attention.

Anybody want to get my attention? No.

Okay.

All right, so we have a meeting scheduled for Monday 5 p.m. All right, so I think that's it. Motion to adjourn.