##VIDEO ID:Mk8K6z99Yoc## [ SOUNDING GAVEL ] >>Karen Perez: THE WORKSHOP FOR OCTOBER 29 IS NOW STARTED ON SELF-FUNDED HEALTH INSURANCE. I'M GOING TO PASS I'M GOING TO PASS IT OVER TO THE SUPERINTENDENT VAN AYRES IN ORDER FOR HIM TO START. >>Van Ayres: THANK YOU, MADAM CHAIR AND BOARD MEMBERS. THIS IS OUR SELF-FUNDED WORKSHOP. WE'VE HAD SOME DISCUSSION ON THIS IN THE PAST THIS IN THE PAST YEARS. BUT JUST TO KIND OF SET THE STAGE FOR THIS, STAGE FOR THIS, HCPS WAS PREVIOUSLY WITH HUMANA IN A FULLY INSURED HEALTH PLAN FOR OVER 25 YEARS AND WE HAD A GREAT EXPERIENCE WITH HUMANA BUT THEY LEFT THE GROUP INSURANCE MARKET. WE SUBSEQUENTLY HELD AN RFP FOR FULLY INSURED HEALTH PLAN AND OUR DISTRICT SELECTED AETNA WHO WE HAVE BEEN WITH SINCE JANUARY 1 OF 2024. TODAY, WE ARE HERE TO EXPLORE THE POSSIBILITY OF MOVING TO A SELF-FUNDED HEALTH INSURANCE PROGRAM IN 2026. DR. DR. PATTON AND DR. SHOTSBERG ALONG WITH LORI PENLEY FROM AON ARE GOING TO WALK US THROUGH THE PRESENTATION. I REALLY WOULD LIKE SOME DIRECTION. THIS IS SOMETHING THAT FROM BEING APPOINTED SUPERINTENDENT, THIS IS DIRECTION I WANTED TO MOVE IN AROUND MOVE IN AROUND SELF-FUNDED FOR VARIOUS REASONS WHICH WE'LL HEAR ABOUT TODAY. I'LL TURN THIS OVER TO DR. PATTON. THERE WILL BE A PRESENTATION AND THEN DISCUSSION AND ULTIMATELY I WOULD LIKE DIRECTION ON MOVING FORWARD WITH SELF-FUNDED HEALTH INSURANCE. DR. PATTON. >> THANK YOU, SUPERINTENDENT. I JUST WANTED TO GIVE A BACKGROUND VERY QUICKLY ON AON, WHICH IS WHICH IS OUR BENEFIT WHICH IS OUR BENEFIT CONSULTANT. AON IS AON IS FOCUSED ON THE SOLE RESPONSIBILITY OF SUPPORTING THE DISTRICT. THEY MAINTAIN A STRONG LOCAL AND NATIONAL RELATIONSHIP WITH ALL CARRIERS AND VENDORS AND UTILIZE THAT MARKET TO LEVERAGE COST AND OPTIMIZE THE SERVICE THAT WE RECEIVE. IT'S REALLY IMPORTANT THAT YOU UNDERSTAND HOW AON IS HERE TODAY AND WHY WE'RE HAVING THEM TO SHARE THE INFORMATION ON THIS EDUCATIONAL, WHICH THIS IS REALLY EDUCATIONAL TO PROVIDE YOU WITH INFORMATION ON THE DIFFERENCES BETWEEN FULLY INSURED AND SELF-INSURED. ONE OF THE OTHER THINGS THAT'S IMPORTANT TO SHARE IS WE'VE GOT LOTS OF REPRESENTATIVES OVER THERE IN THE AUDIENCE THAT AMONGST ALL OF THEM COLLECTIVELY, MORE THAN 70 YEARS OF EXPERIENCE OF INDIVIDUALS WHO SPECIALIZE IN THIS PARTICULAR AREA. THAT WAY WE MAKE SURE WE DO HAVE INDIVIDUALS THAT CAN PROVIDE US, IF THERE ARE QUESTIONS OR CONCERNS AROUND WHAT CERTAIN THINGS MEAN, THEY CAN ANSWER THOSE QUESTIONS. WE WANT TO ALSO MAKE SURE THAT YOU UNDERSTAND THAT THEY HAVE WORKED WITH THE PUBLIC SECTOR BEFORE AS BEFORE AS WELL, AND THAT WE HAVE HAD A RELATIONSHIP WITH THEM THAT HAS BEEN VERY SUCCESSFUL THUS FAR, HOWEVER WE DO WANT YOU TO HAVE THE OPPORTUNITY TO FILL IT IF THERE ARE QUESTIONS OR CONCERNS YOU HAVE AROUND WHAT THEIR SUPPORT IS OR WHAT THEY DO WITH THE INDIVIDUALS IN THE AUDIENCE OR WITH LORI AS SHE GOES THROUGH THIS. WE DO ASK THAT WE HAVE A CHANCE TO GO THROUGH THE ACTUAL PRESENTATION ITSELF BECAUSE THERE IS A LOT OF INFORMATION IN HERE THAT WE PROVIDED IN ORDER TO ANSWER SPECIFIC QUESTIONS FOR YOU. IF YOU'LL ALLOW US TO GO THROUGH THAT AND HOLD YOUR QUESTIONS UNTIL AFTER SO THAT WAY WE CAN BE VERY SPECIFIC TO ANSWER WHAT YOU NEED. WITH THAT, I'LL TURN IT OVER TO LORI. >> THANK YOU. >> [INAUDIBLE] -- WAYS TO MITIGATE MITIGATE INCREASES WHICH MITIGATE INCREASES WHICH -- MITIGATE INCREASES WHICH -- OH, THANK YOU. CAN YOU HEAR ME? I'M A SOFT TALKER. SORRY. SO WE'LL START WITH A GLOSSARY OF TERMS. THIS IS SOMETHING SO THAT AS WE PROGRESS THROUGH OUR DISCUSSION TODAY AND THEN SOMETHING THAT YOU'LL HAVE FOR REFERENCE. THE SELF FUNDED AND FULLY INSURED I WON'T SPEND A LOT THERE BECAUSE THAT'S WHAT MOST OF THE PRESENTATION WILL BE. BUT THE BIGGEST DIFFERENCE BETWEEN BEING SELF-FUNDED AND BEING FULLY INSURED IS THAT THE EMPLOYER IN THE SELF-FUNDED PLAN HAS THE HAS THE FINANCIAL LIABILITY OF THE PLAN AND FULLY INSURED THE INSURANCE CARRIER HAS THE FINANCIAL LIABILITY. CLAIMS ARE PROBABLY THE BIGGEST PART OF ANY MEDICAL PLAN, WHETHER YOU'RE FULLY INSURED OR SELF-FUNDED. USUALLY 80 TO 90 PERCENT OF YOUR TOTAL COSTS. THOSE ARE THE MEDICAL SERVICES THAT THAT EMPLOYEES AND MEMBERS HAVE DONE AND GOES TOWARDS THE CLAIMS AND THAT IS THE COST OF THE PROGRAM. AND LOOKING AT PREMIUMS VERSUS BUDGET RATES, THEY ARE ALMOST THE SAME THING. WE REFER TO PREMIUMS WHEN WE'RE TALKING ABOUT A FULLY INSURED PLAN. THE INSURANCE CARRIER SETS THOSE PREMIUMS AND A SELF-FUNDED PLAN, WE REFER TO THEM AS BUDGET RATES. SO THERE IS A PROJECTION AND WE CREATE RATES THAT HOPEFULLY WILL COVER THE COST OF THE PLAN. AND IN BOTH AND IN BOTH CASES, THE PREMIUMS AND THE BUDGET RATES ARE SET, AND INTENDED TO COVER THE COST OF THE PLAN THAT DOESN'T ALWAYS HAPPEN, BUT THAT'S THE INTENTION UP FRONT. LOSS RATIO IS REALLY LOSS RATIO IS REALLY A WAY TO LOOK TO SEE HOW YOUR PLAN IS RUNNING. SO YOU'RE REALLY COMPARING THE CLAIMS THAT ARE BEING CLAIMS THAT ARE BEING INCURRED TO THE PREMIUMS OR THE BUDGET RATES. AND YOU WANT THAT TO ALWAYS BE AT LIKE A 90 AT LIKE A 90 TO 100% RATIO. ONCE YOU GET ABOVE 100%, THEN THAT'S WHEN YOUR CLAIMS ARE EXCEEDING YOUR BUDGET. THE FLORIDA THE FLORIDA STATUTE IS SOMETHING THAT FLORIDA STATE HAS ITS STATUTE 112.08. IT IS REQUIRED BY IT IS REQUIRED BY ALL MUNICIPALITIES TO HAVE TO PROVIDE A PLAN UP FRONT ON HOW YOU WILL HOLD A YOU WILL HOLD A 60-DAY CLAIMS RESERVE. AND AND THEN THERE IS AN TION TO THE STATE OF FLORIDA SHOWING THAT YOU ARE FOLLOWING THE PLAN AND THAT YOU'RE ABLE TO MAINTAIN THOSE RESERVES. THEY JUST WANT TO MAKE SURE YOU'LL BE ABLE TO PAY FOR THE CLAIMS. STOP LOSS INSURANCE. WE'LL GET INTO AN EXAMPLE LATER, BUT IT HELPS TO MAXIMIZE LIABILITY, WHETHER IT'S LIABILITY, WHETHER IT'S ON AN INDIVIDUAL HIGH-COST CLAIM OR AGGREGATE FOR THE OVERALL PROGRAM. THE NEXT SLIDE, A LITTLE OUT OF ORDER, BUT START WITH PHARMACY BENEFIT MANAGER. THAT IS THE THAT IS THE INTERMEDIARY BETWEEN THE DRUG MANUFACTURERS AND THE INSURANCE CARRIER OR THE EMPLOYER IF YOU ARE SELF FUNDED. TODAY, YOUR TODAY, YOUR PBM IS CVS, WHICH IS PART OF AETNA. AND THEN INSURANCE CARRIER, SO YOU ARE ALL FAMILIAR, MENTIONED HUMANA AND NOW HUMANA AND NOW AETNA. THEY CAN OFFER FULLY INSURED OR SELF-FUNDED PLANS. THEY CAN BUNDLE EVERYTHING TOGETHER. ANOTHER OPTION, IF YOU'RE SELF-FUNDED, IS TO USE A TPA TO DO THE ADMINISTRATIVE PROCESS FOR YOU. AND THEY ARE PROCESSING THE CLAIMS AND THEN IT TAKES IT AWAY FROM AN INSURANCE CARRIER. EITHER WAY IS A GOOD OPTION. AND THEN JUST TALKING A LITTLE BIT ABOUT A CONSULTANT. SO WE MENTIONED THAT AON, WE ARE THE BENEFIT SUBJECT MATTER EXPERTS. WE COVER ALL BENEFITS, WHETHER MEDICAL, DENTAL, VISION, LIFE. WE'RE AN WE'RE AN OBJECTIVE PARTY THAT WE ARE WORKING WITH THE DISTRICT TO CREATE A STRATEGY ON YOUR -- ALL YOUR BENEFIT PROGRAMS. AND THEN HELP TO IMPLEMENT THAT STRATEGY AND THERE IS CERTAINLY A LOT IN BETWEEN. BUT JUST TRYING TO DIFFERENTIATE BETWEEN WHAT EACH OF THOSE ARE. ON THE NEXT SLIDE, WE'LL START TO LOOK AT THE DIFFERENCE BETWEEN FULLY INSURED AND SELF-FUNDED. AND UNDER FULLY INSURED AND UNDER FULLY INSURED PLAN, THE EMPLOYER IS PAYING THE PREMIUM TO AN INSURANCE PREMIUM TO AN INSURANCE CARRIER, AND THEY ARE DOING THE ADMINISTRATIVE WORK. UNDER A SELF-FUNDED PLAN, THE EMPLOYER IS EMPLOYER IS PAYING, WHICH IS A FRACTION OF THE FRACTION OF THE COST, A MONTHLY FEE TO THE ADMINISTRATOR, WHICH IS EITHER THE INSURANCE CARRIER OR THE TPA, TO DO THE -- HANDLE THE ADMINISTRATION OF THE PROGRAM. THE CASH FLOW IS DIFFERENT UNDER A FULLY INSURED PLAN AND YOU'RE PAYING PAYING FIXED MONTHLY PREMIUMS UNDER A UNDER A SELF-FUNDED PLAN, YOU'RE PAYING THE ADMINISTRATIVE MONTHLY FEES, BUT YOU ARE ALSO HOLDING ON TO THE CASH AND PAYING THE CLAIMS AS THEY INCUR OR THEY OCCUR. UNDER BENEFITS A UNDER BENEFITS A FULLY INSURED PLAN, THERE IS LITTLE LESS FLEXIBILITY. THERE ARE STATE MANDATES ON THEIR BENEFITS, BUT ALSO YOU'RE ACCEPTING THE PACKAGE THAT THEY ARE PROVIDING WITH YOU BASED ON THE PREMIUMS IN THE BENEFIT PLANS. UNDER A UNDER A SELF-FUNDED PLAN, YOU DON'T HAVE THOSE STATE MANDATES. YOU'RE NOT HELD TO THOSE, BUT AT THE SAME THE SAME TIME, YOU HAVE THE ABILITY TO GO OUTSIDE AND ACTUALLY PURCHASE HEALTH MANAGEMENT PROGRAMS, WHICH IS WHAT WE'LL GET INTO MORE DETAIL ABOUT WHAT THOSE LOOK LIKE. BUT THOSE ARE THE PROGRAMS BUT THOSE ARE THE PROGRAMS THAT CAN TARGET CERTAIN DISEASE STATES, WHICH YOU SEE WITHIN YOUR CLAIMS TO HELP BENEFIT YOUR EMPLOYEES. AND THE CLAIM LIABILITY THAT'S PROBABLY THE BIGGEST DIFFERENCE, AGAIN, FULLY INSURED PLAN, THE CARRIER CARRIER IS 100% LIABLE. YOU'RE PAYING PREMIUMS. IF CLAIMS EXCEED THE PREMIUMS, THE CARRIER THE CARRIER PAYS FOR THOSE CLAIMS. IN THE CASE OF A SELF-FUNDED PLAN, IF YOUR CLAIMS ARE BELOW WHAT YOU THINK YOUR BUDGET IS, THEN YOU RETAIN THAT AND YOU CAN USE THAT FOR FUTURE YEARS OR IF THE CLAIMS EXCEED YOUR BUDGET, YOU'RE STILL RESPONSIBLE TO MAKE THOSE PAYMENTS. ON THE NEXT SLIDE, ON THE NEXT SLIDE, FULLY INSURED PLANS, THEY ARE PLANS, THEY ARE ASSESSED A STATE TAX THAT CAN BE UP TO 3% OF PREMIUM. CURRENTLY, THAT PORTION OF YOUR PLAN IS PLAN IS AROUND $5 MILLION. UNDER A UNDER A SELF-FUNDED PLAN, THERE ARE NO STATE TAXES ASSESSED. SO THAT'S AN IMMEDIATE COST THAT YOU'RE NOT PAYING ANY LONGER. AND THEN PLAN FIDUCIARY UNDER FULLY INSURED PLAN, THE CARRIER IS THE PLAN FIDUCIARY. UNDER A UNDER A SELF-FUNDED PLAN, THE EMPLOYER IS THE PLAN EMPLOYER IS THE PLAN FIDUCIARY. YOU CAN OUTSOURCE SOME OF THOSE RESPONSIBILITIES TO THE CARRIER BY PAYING AN ADDITIONAL ADMINISTRATIVE FEE, BUT ULTIMATELY THE EMPLOYER IS THE ULTIMATE PLAN FIDUCIARY. SO THEN WE'LL TALK A LITTLE BIT ABOUT INDIVIDUAL STOP LOSS INSURANCE. AND THERE WAS A QUESTION ON HOW MUCH STOP LOSS INSURANCE MUCH STOP LOSS INSURANCE YOU MIGHT NEED. UNDER A CARRIER MAY HAVE SOME STOP LOSS BUILT INTO THEIR PROGRAM. FOR A SELF-FUNDED FOR A SELF-FUNDED PLAN, THAT'S AN OPTION FOR YOU. FOR A LARGE GROUP, WE WOULD TYPICALLY SEE SOMEWHERE TYPICALLY SEE SOMEWHERE BETWEEN 750 750 TO $100 MILLION. THIS IS THE CAP PLACED ON HIGH-COST CLAIM. SO AN EXAMPLE WOULD BE YOU PAY A PREMIUM TO PREMIUM TO THE REINSURANCE CARRIER. YOU HAVE A CLAIM YOU HAVE A CLAIM THAT'S $1.3 MILLION. YOUR STOP LOSS, INDIVIDUAL STOP LOSS IS A MILLION, SO THE DIFFERENCE IS 300,000, AND THAT IS REIMBURSED BACK TO THE DISTRICT. OR TO THE EMPLOYER. THERE'S MORE DETAIL AROUND STOP LOSS INSURANCE, TOO, IF YOU'RE INTERESTED ON INTERESTED ON SLIDE 19 IN THE APPENDIX. SO MOVING SO MOVING TO THE SO MOVING TO THE NEXT SLIDE, THERE ARE DEFINITE ADVANTAGES FOR A LARGE EMPLOYER TO BE SELF FUNDED. YOU HAVE BETTER OVERSIGHT OF YOUR CLAIMS. YOU HAVE MORE FLEXIBILITY IN HOW YOU MANAGE YOUR CLAIMS, YOU MANAGE YOUR CLAIMS, PROGRAMS THAT YOU CAN IMPLEMENT, AND THERE ARE CERTAIN THINGS YOU CAN CARVE OUT, FOR INSTANCE, IF YOU WANTED TO CARVE OUT YOUR PRESCRIPTION DRUG COVERAGE. WE WANTED TO WE WANTED TO JUST WE WANTED TO JUST INCLUDE A CHART OF SOME OF THE LARGER DISTRICTS IN FLORIDA, SCHOOL DISTRICTS IN FLORIDA THAT ARE CURRENTLY CURRENTLY SELF-FUNDED. I APOLOGIZE. SOMEHOW WE LEFT OFF BROWARD, WHO WAS WITH AETNA. AND THEY HAVE AND THEY HAVE ABOUT AND THEY HAVE ABOUT 27,000 EMPLOYEES. ALL OF THESE HAVE BEEN SELF-FUNDED FOR A LONG SELF-FUNDED FOR A LONG TIME. THE NEWEST ONE IS PROBABLY PINELLAS, AND THAT WAS BACK IN 2017. THEY WERE WITH THEY WERE WITH HUMANA FULLY INSURED. THEY STAYED WITH HUMANA WHEN THEY MOVED TO SELF-FUNDING FOR A COUPLE OF YEARS BEFORE THEY DID AN RFP AND NOW I BELIEVE THEY ARE WITH AETNA ARE WITH AETNA. THE NEXT SLIDE, ONE OF THE QUESTIONS WAS AROUND PROS AND CONS OF BEING SELF-FUNDED CONS OF BEING SELF-FUNDED. DEFINITELY ON THE LEFT-HAND SIDE WE'LL TALK ABOUT THE PROS. SO YOU ELIMINATE THE CARRIER PROFIT MARGIN. YO YOU ELIMINATE THE STATE PREMIUM TAX. WE TALKED ABO WE TALKED ABOUT THE PLAN FLEXIBILITY. JUST THE ABILITY TO BETTER ANALYZE YOUR CLAIMS TO SEE MORE IN REAL TIME WHAT'S DRIVING THOSE CLAIMS. AND THEN THE AND THEN THE OPTION AND THEN THE OPTION TO CARVE OUT OUR EXIT IF THAT'S WHAT YOU WANTED TO DO, AND THEN WE ALSO MANAGED THE HEALTH MANAGEMENT PROGRAMS THAT YOU CAN ADD INTO THE PLANS THAT YOU CAN'T DO WHEN YOU'RE FULLY INSURED. SOME OF THE CONS WOULD SOME OF THE CONS WOULD BE THERE ARE CERTAIN FEES, AN EXAMPLE WOULD BE WELL-BEING FEES AND INCENTIVES THAT IF FULLY INSURED CARRIER MIGHT PROVIDE TO YOU OUTSIDE OF YOUR ACTUAL PREMIUM COST. THOSE WOULD NOW BE THE EMPLOYER'S EMPLOYER'S RESPONSIBILITY. THEY CAN STILL BE HANDLED BY THE CARRIER, BUT THERE WOULD JUST BE AN ADMINISTRATIVE COST THAT WOULD BE PART OF YOUR OVERALL FEES. AND THEN, OF COURSE, THE EMPLOYER'S RESPONSIBLE FOR PAYING CLAIMS, EVEN WHEN THEY EXCEED YOUR BUDGET. AND THAT JUST GOES TO THE VOLATILITY OF THE PROGRAM. WE'VE SEEN WE'VE SEEN THAT ALMOST ALL CLIENTS, THEIR CLAIMS WILL VARY OVER THE YEARS. SOME YEARS WILL BE BETTER THAN OTHERS. THEN YOU ALSO HAVE THE HIGH-COST CLAIMANTS THAT SOME YEARS THOSE WILL BE BETTER THAN OTHERS. SO THAT'S JUST THE SO THAT'S JUST THE PART THAT MAKES IT A LITTLE BIT RISKY. 112.08, WE TALKED ABOUT 112.08, WE TALKED ABOUT THAT. ALSO, JUST AN INCREASED ADMINISTRATIVE COMPLEXITY. THAT THAT BANKING RELATIONSHIP THAT YOU HAVE PROBABLY THERE'S MORE RESPONSIBILITY THAT YOU WOULD HAVE INTERNALLY AND WE'LL ALSO TOUCH ON THAT AS TOUCH ON THAT AS WELL. ON THE NEXT SLIDE, WE START TO LOOK AT COSTS. I JUST CAUTION THAT WHEN WE GET TO THE INSURANCE CARRIER PORTION, AND WE'RE LOOKING AT PROJECTED CLAIMS, THOSE ARE PROJECTIONS. THEY ARE BASED OFF THEY ARE BASED OFF OF JUST SIMPLY -- SIMPLY PUT YOUR ACTUAL CLAIMS CLAIMS AND THEN WE HAVE TO PROJECT THEM FORWARD BASED OFF OF TREND OR PART OF THAT IS MEDICAL INFLATION. SO JUST THE COST SO JUST THE COST OF CARE INCREASING. ACTUAL WILL DEPEND ON WHAT HAPPENS THROUGHOUT THE HAPPENS THROUGHOUT THE YEAR, BUT FOR THIS CONVERSATION, JUST WANTED TO POINT OUT, SO THE PREMIUMS WE KNOW WHAT THEY ARE GOING TO BE. AND IF AND IF WE LOOK AND IF WE LOOK AT 2024 AND YOUR PREMIUM AT THE $186 MILLION, AND THEN WHEN WE GO DOWN TO THE INSURANCE CARRIER INSURANCE CARRIER COSTS, YOU CAN SEE THAT YOUR PROJECTED CLAIMS -- AND I MENTIONED THAT THEY ARE THE GREATEST PART OF YOUR TOTAL COSTS, ARE ACTUALLY HIGHER THAN WHAT THE PREMIUMS ARE. SO THERE IS A BIT OF A GAP. YOU'RE NOT RESPONSIBLE FOR THAT UNDER THE FULLY INSURED PLAN. MOVING INTO MOVING INTO '25, MOVING INTO '25, WE KNOW WHAT YOUR 2025 COSTS WILL BE. SO WE'RE LOOKING SO WE'RE LOOKING AT THE SO WE'RE LOOKING AT THE 196, PROJECTING CLAIMS. NOW FORWARD TO THE END NOW FORWARD TO THE END OF 2025, YOU CAN SEE THEY ARE INCREASING. SO WE SO WE STILL HAVE A GAP. SO AS WE MOVE TO THE NEXT SLIDE, WHAT THAT MEANS, WHAT THE GAP REALLY MEANS IS THAT AT SOME POINT, IF YOU REMAIN FULLY INSURED, THE INSURED, THE CARRIER IS GOING TO ASK FOR A MUCH LARGER INCREASE THAN WHAT YOU HAVE SEEN IN THE PAST. AND IN THIS ILLUSTRATION FOR 2026 FULLY INSURED, WE'RE NOT EVEN -- WE'RE SAYING, ALL RIGHT, WE NEGOTIATE AND WE MAKE SOME PLAN CHANGES TO TRY TO BRING THAT INCREASE DOWN, BUT WE STILL KNOW KNOW IT'S GOING TO BE HIGH. AND THEN OUR OPTIONS TO TRY TO BRING BRING THAT COST DOWN ARE FAIRLY LIMITED AND THINGS LIKE HIGHER DEDUCTIBLES, HIGHER COPAYS, AND OUT-OF-POCKET COSTS. SO EACH TIME YOUR EMPLOYEES GO TO THE DOCTOR, THEY'LL SEE AN INCREASE INCREASE IN INCREASE IN THEIR COSTS AS WELL AS LIKELY AN INCREASE IN THEIR PREMIUM. WHEN WE GET WHEN WE GET TO 2026, THERE'S STILL AN INCREASE, BUT YOU HAVE MORE OPTIONS TO TRY TO BRING THAT INCREASE DOWN. ONE OF THE THINGS YOU AUTOMATICALLY SEE IF YOU LOOK IN 2026 FULLY INSURED TO SELF-FUNDED, UNDER ADMINISTRATIVE COSTS, YOU CAN SEE THAT THOSE ADMINISTRATIVE COSTS ARE A LOT LOWER UNDER THE SELF-FUNDED PLAN. AND THEN, OF COURSE, WE'RE ELIMINATING THAT ELIMINATING THAT STATE PREMIUM TAX UNDER A TAX UNDER A SELF-FUNDED PLAN FOR THE PRESCRIPTION DRUG PROGRAM, YOU YOU RETAIN THE REBATES AND BY RETAINING THOSE, THEN THAT HELPS TO OFFSET YOUR CLAIM COSTS TO HELP BRING THAT DOWN. AND THEN TRYING TO IMPROVE THE FORMULARY OVER TIME SO FORMULARY OVER TIME SO THAT YOU'RE MAKING SURE YOU'RE USING THE BEST DRUGS BUT ALSO USING THE MOST COST-EFFECTIVE DRUGS. AND THEN THE MAIN DIFFERENCE HERE IS HERE IS WE'LL HERE IS WE'LL TALK ABOUT OTHER OPPORTUNITIES AS WE MOVE TO OPPORTUNITIES AS WE MOVE TO THE NEXT SLIDE. SO WE'RE SO WE'RE ILLUSTRATING SOME IMMEDIATE AND SHORT-TERM SOLUTIONS VERSUS SOME LONGER TERM TERM SOLUTIONS.  SO THAT IMMEDIATE AND SHORT TERM, THOSE ARE THINGS YOU MIGHT WANT TO CONSIDER, HAVE READY TO CONSIDER, HAVE READY TO GO ON DAY ONE WHEN YOU START YOUR PLAN. THE MAIN THING THAT I WANT TO TALK ABOUT HERE IS THAT THOSE PROGRAMS CAN BE PROGRAMS CAN BE VOLUNTARY OR MANDATORY. THE IMPORTANT THING IS THAT YOU GET EMPLOYEE PARTICIPATION. YOU'RE ASKING THEM TO SUCCESS THEIR CARE IN A SLIGHTLY DIFFERENT WAY THAN WHAT THEY ARE USED TO BUT THE INTENT IS FOR BETTER HEALTH. SO THE GREATER THE ENGAGEMENT, THE GREATER THE SAVINGS. THINK ABOUT WHAT YOU DO TODAY UNDER YOUR WELL-BEING PROGRAM, AND YOU HAVE A GROUP OF PEOPLE THAT THAT ARE OUT THERE REALLY HELPING PEOPLE TO ENGAGE IN THEIR HEALTH CARE MIGHT BE LIFESTYLE CHANGE, MAKING SURE THAT THEY ARE GETTING THEIR PREVENTIVE SERVICES, SO YOU'RE ALREADY DOING SOMETHING LIKE THAT, AND THIS IS JUST TAKING IT ONE STEP FURTHER. AND THE AND THE OTHER THING AROUND ACCESSING THE CARE ACCESSING THE CARE DIFFERENTLY, LITTLE DIFFERENT FROM TRADITIONAL HEALTH, BUT THE BETTER CARE PEOPLE BETTER CARE PEOPLE RECEIVE, THE BETTER THE OUTCOMES IN THEIR HEALTH. SO THAT'S WHAT WE'RE TRYING TO ILLUSTRATE HERE. SOME OF THE SOME OF THE ITEMS AND YOU CAN SEE TRANSPARENCY AND STEERAGE, BUNDLED BUNDLED SURGERY, AND THE BUNDLED SURGERY, AND THE VIRTUAL MUSCULOSKELETAL, THERE IS A LITTLE MORE DETAIL ON SLIDE 22 IN THE IN THE APPENDIX IF YOU WANTED TO TAKE A LOOK AT THAT. IT GIVES YOU IT GIVES YOU JUST SOME EXAMPLES OF THE DIFFERENT VENDORS OUT THERE. TRANSPARENCY AND TRANSPARENCY AND STEERAGE IS PROVIDING -- I'LL GO THROUGH THESE QUICKLY. PROVIDING TOOLS THAT WILL HELP STEER YOUR EMPLOYEES TO THE BEST PHYSICIANS OR FACILITIES. A BUNDLED SURGERY IS WHERE YOU'RE WORKING YOU'RE WORKING WITH A VENDOR WHO'S ALREADY NEGOTIATED. FOR EXAMPLE, KNEE FOR EXAMPLE, KNEE SURGERIES. AND THEY CAN TELL YOU THAT THE BEST PLACE TO HAVE A KNEE SURGERY IS AT A CERTAIN HOSPITAL SYSTEM. SO YOU CAN SET IT UP TO TRY TO INCENT YOUR EMPLOYEES TO GO TO THAT. IT CAN BE A LITTLE INCONVENIENT, BUT IF THAT'S WHERE THEY'LL GET THE BEST OUTCOMES, THEN YOU'RE ENCOURAGING THEM TO DO WHAT'S RIGHT FOR THEM. UNDER THE VIRTUAL MSK, THAT IS A DIGITAL PHYSICAL THERAPY. SO IT JUST -- IT MAKES IT MORE CONVENIENT FOR PEOPLE TO RECEIVE THEIR PHYSICAL THEIR PHYSICAL THERAPY. THEY DON'T NECESSARILY HAVE TO TAKE TIME OFF. THE TEACHERS TAKE TIME OFF TO ACTUALLY GO. THEY CAN DO IT AT ANY TIME THAT'S CONVENIENT FOR THEM. WE TALKED A LITTLE BIT. WE TALKED ABOUT PHARMACY CARVE-OUT, BUT THE REASON TO DO THAT IS TO AT LEAST LOOK. YOU MAY WANT TO YOU MAY WANT TO LOOK AND CONSIDER IS THERE ANOTHER CONSIDER IS THERE ANOTHER PBM OUT THERE THAT MIGHT PROVIDE BETTER DISCOUNTS FOR THE DRUGS THAT YOUR EMPLOYEES ARE TAKING. THE THING ABOUT THIS -- THESE SOLUTIONS IS THAT THERE ARE HUNDREDS THAT HAVE HUNDREDS THAT HAVE COME OUT OVER THE LAST SEVERAL YEARS. AND YOU REALLY NEED TO VET THEM. YOU DON'T JUST IMPLEMENT THEM. AND, AGAIN, THAT'S PART OF WHAT WE WOULD WE WOULD HELP WITH. BUT YOU HAVE TO KNOW HOW LONG HAVE THEY BEEN IN BUSINESS, WHAT THEIR BOOK OF BUSINESS RESULTS HAVE LOOKED LIKE. WHAT THE COST WOULD BE TO THE DISTRICT TO HAVE IT AND WHAT THE POSSIBLE SAVINGS POSSIBLE SAVINGS OR POSSIBLE SAVINGS OR RETURN ON INVESTMENT WOULD BE AND THEN ANNUALLY MAKING SURE THAT IF THEY ARE TELLING YOU, YOU SHOULD HAVE A CERTAIN RETURN ON INVESTMENT, THAT YOU'RE ACTUALLY RECEIVING RECEIVING THAT. YOU WANT TO BE ABLE TO ACTUALLY REVIEW THE RESULTS, MAKE SURE THAT THEY ARE HAPPENING. ON THE LONGER ON THE LONGER TERM SOLUTIONS, THOSE ARE THINGS THAT PROBABLY WOULD CAUSE WOULD CAUSE A LITTLE MORE -- I WANT TO SAY NOISE, BUT MAKE EMPLOYEES A LITTLE MORE UNCOMFORTABLE. SO PROBABLY SAVE THOSE FOR ANOTHER TIME. BUT THEY ARE JUST GIVING YOU AN IDEA THAT THERE ARE LOTS OF OPTIONS OUT OPTIONS OUT THERE, AND THERE WILL CONTINUE TO BE LOTS OF OPTIONS THAT COME OUT INTO THE MARKET FOR YOU TO CONSIDER. ON THE NEXT SLIDE, LOOKING AT SHOULD THE DISTRICT DECIDE TO GO SELF-FUNDED, WHAT THAT EXECUTION MIGHT LOOK LIKE. CURRENTLY YOU HAVE TWO OPTIONS. THE FIRST THE FIRST OPTION IS TO REMAIN WITH AETNA. SO YOU AUTOMATICALLY GET THE BENEFITS OF BEING BENEFITS OF BEING SELF-FUNDED, BUT YOU'RE NOT CHANGING BUT YOU'RE NOT CHANGING VENDORS. SO YOUR EMPLOYEES ARE SEEING THE SAME DOCTORS. THEY REALLY DON'T EVEN REALIZE THAT YOU'RE SELF-FUNDED UNLESS YOU PUT THESE OTHER PROGRAMS IN. VERSUS THE SECOND OPTION IS TO DO A FULL MARKETING. THE TIMELINE IT TAKES A LITTLE LONGER, BUT THERE IS A LOT OF DETAIL THAT GOES INTO THE DETAIL THAT GOES INTO THE RFP, SO YOU WANT TO MAKE SURE THAT YOU'RE YOU'RE ASKING ALL OF THE QUESTIONS, YOU'RE LOOKING AT ALL OF THEIR CLINICAL PROGRAMS, ALL OF THE OF THE FINANCIALS. YOU WANT TO COMPARE NETWORK DISCOUNTS. YOU WANT TO COMPARE PRESCRIPTION DRUG DISCOUNTS AND THEN DISRUPTIONS, THE MEDICAL NETWORK, MAKING SURE THAT YOUR EMPLOYEES, IF YOU WERE TO MOVE TO ANOTHER VENDOR, THAT THEY ARE STILL ABLE TO SEE THEIR CURRENT PHYSICIANS AND GO TO THE SAME FACILITIES. AND THE SAME WITH YOUR RX FORMULARY AND FORMULARY AND PHARMACIES. ON THE NEXT SLIDE, JUST LOOKING AT THE TIMELINE, YOU CAN SEE FOR MOVING TO OPTION ONE REALLY STARTING IN THE MIDDLE OF 2025, THERE IS THE BANKING ARRANGEMENT THAT HAS TO BE SET THAT HAS TO BE SET UP, ALONG WITH SOME OTHER THINGS. AND THEN IF YOU DO AND THEN IF YOU DO FULL MARKETING, REALLY TO MARKETING, REALLY TO HIT MARKETING, REALLY TO HIT THE 1/20/26 -- 1/2026 DATE, LOOKING TO START THIS IN NOVEMBER. IT IT IS A COMPLICATED PROCESS WORKING WITH YOUR PROCUREMENT. IN THE PAST, ANN HAS IN THE PAST, ANN HAS ALWAYS PROVIDED THE -- HELPING WITH THE RFP, PROVIDING ALL THE QUESTIONS, COLLECTING ALL THE DATA THAT GOES INTO IT. AND THEN HOPEFULLY RELEASING THE RFP IN DECEMBER, FOLLOWING ALL THE RULES OF PROCUREMENT, CARRIER RESPONSE IS DUE SOMETIME IN PROBABLY MID TO END OF JANUARY, DEPENDING ON WHEN THE RFP IS RELEASED. AND THEN ONCE THAT DATA COMES BACK, COLLECTING ALL THE DATA, PUTTING TOGETHER THE ANALYSIS. PUTTING TOGETHER THE COMPARISON, PRESENTING IT TO PRESENTING IT TO THE INSURANCE COMMITTEE. THERE'S SOME BACK AND THERE'S SOME BACK AND FORTH, BEST OF BEST OF FINAL. COULD BE FINALIST PRESENTATIONS WITH SOME OF THE WITH SOME OF THE VENDORS, AND THEN INSURANCE COMMITTEE CREATING THAT FINAL RECOMMENDATION, TAKING IT RECOMMENDATION, TAKING IT TO THE BOARD END OF BOARD END OF MAY, BEGINNING OF JUNE, TO APPROVE AND THEN STARTING IMPLEMENTATION IN JULY. AGAIN, THAT'S JUST A VERY -- IF YOU WERE TO CHANGE VENDORS, SETTING UP NEW CLAIM SYSTEMS IS JUST VERY DETAILED. SO MAKING SURE YOU HAVE ENOUGH TIME. SO YOU'RE READY FOR YOUR OPEN ENROLLMENT IN SEPTEMBER AND THEN YOU'RE ALL SET TO GO ON 1/1/2026. AND THEN, FINALLY, THERE WAS A QUESTION AROUND INFRASTRUCTURE, WHAT INFRASTRUCTURE IS WHAT INFRASTRUCTURE IS NEEDED TO BE SUCCESSFUL. WOULD MOVING TO WOULD MOVING TO SELF-FUNDING REQUIRE MORE INTERNAL STAFF IN HR TO SUPPORT IT? SO WE'RE SO WE'RE SHOWING SOME OF THE ADDITIONAL ADDITIONAL HCPS RESPONSIBILITIES. TALKED ABOUT THE BANKING THAT HAS TO BE SET HAS TO BE SET UP TO PROCESS CLAIMS. YOU NEED TO BE YOU NEED TO BE REVIEWING YOU NEED TO BE REVIEWING YOUR HIGH-CLAIMANTS ESPECIALLY IF YOU HAVE STOP LOSS TO MAKE SURE YOU'RE RECEIVING REIMBURSEMENTS. AND THEN JUST THE ONGOING MANAGEMENT OF NOT ONLY THE CLAIMS, BUT ALSO THE DIFFERENT VENDORS THAT YOU VENDORS THAT YOU PUT IN PLACE. DEFINITELY GREATER VENDOR MANAGEMENT AND OVERSIGHT. AND THEN YOU MAY WANT TO CONSIDER AN ADDITIONAL CONSIDER AN ADDITIONAL FTE, MAYBE SOMEBODY WITH A FINANCIAL BACKGROUND SO AS THEY ARE REVIEWING CLAIMS, THEY ARE COMFORTABLE LOOKING AT ALL THE NUMBERS AND MAYBE CHECKING TO SEE IF THEY ARE SEEING ANY IRREGULARITIES IN THE IRREGULARITIES IN THE BANKING. ALSO COMPLIANCE REPORTING THAT TODAY IS COMPLETED TODAY IS COMPLETED BY THE CARRIERS WOULD THEN HAVE TO CARRIERS WOULD THEN HAVE TO BE COMPLETED BY HILLSBOROUGH. SO SO THAT'S IT. WE DO HAVE INFORMATION IN THE APPENDIX. I DON'T KNOW IF YOU GUYS HAVE HAD A CHANCE TO LOOK AT HAD A CHANCE TO LOOK AT IT. I'M HAPPY TO GO THROUGH IT OR IF YOU WANT TO ASK SOME QUESTIONS. >>Van Ayres: THANK YOU MS. PENLEY. THAT IS THE PRESENTATION ON SELF-FUNDED. I WANT TO BE CLEAR, IT IS MY HOPE THAT THE DIRECTION THAT WE COME OUT OF HERE, MY WISH IS TO MOVE TOWARDS SELF-FUNDED INSURANCE FOR 2026. YOU SAW ON THE ONE SLIDE THERE ARE REALLY TWO OPTIONS TO DO SO BUT I WANTED TO GET SOME DISCUSSION GOING AROUND THAT BUT WANT TO BE CLEAR MY DIRECTION AND WHAT I WANT AND THAT IS TO MOVE FORWARD WITH SELF FUNDED FOR 2026 AND THERE ARE OPTIONS. OPEN TO DISCUSSION TODAY AND HOPEFULLY GET SOME DIRECTION BY THE CLOSE THE CLOSE OF THIS WORKSHOP FOR OUR STAFF TO MOVE FORWARD. THAT CONCLUDES OUR PRESENTATION. DR. DR. PATTON, ANYTHING ELSE? >> NO. WE JUST WOULD OPEN IT UP AGAIN TO ANSWER ANY QUESTIONS, HEAR COMMENTS FROM YOU AND THOUGHTS. IF THERE IS ADDITIONAL INFORMATION YOU MIGHT INFORMATION YOU MIGHT NEED, WE DO HAVE INDIVIDUALS THAT CAN ANSWER THAT FOR YOU. >> THANK YOU. MEMBER GRAY, YOU MEMBER GRAY, YOU ARE FIRST IN THE QUEUE. >>Lynn Gray: THANK YOU, MEMBER VAUGHN. THANK YOU MS. SHOTSBERG AND DR. PATTON AND AON, THANK PATTON AND AON, THANK YOU FOR YOUR PRESENTATION. THIS IS JUST SOME CONSIDERATIONS BECAUSE I'VE BEEN THROUGH THIS COMPARISON, AS TRACY KNOWS, THIS WOULD BE THE THIRD OR FOURTH TIME. SO ONE OF THE CONSIDERATIONS IS CHANGE FATIGUE. RIGHT NOW WE'RE DEALING WITH SYNERGY. WE HAD PAST HURRICANES, PERHAPS IN THE FUTURE, HOPEFULLY NOT. BUT THERE WILL BE AN INCREASE, AND THIS IS REGARDING SELF-INSURED. THERE WILL BE INCREASED ADMINISTRATIVE COSTS. AND THESE ARE AND THESE ARE CONSIDERATIONS. WE'RE TALKING WE'RE TALKING BANKING, TALKING FTE, TALKING COMPLIANCE. SO THERE WILL BE SO THERE WILL BE INCREASED ADMINISTRATIVE COSTS. SYNERGY, WILL IT HAMPER WITH THIS IDEA, WILL IT HAMPER RECRUITMENT FOR TEACHERS? BECAUSE AGAIN THIS IS ANOTHER LAYER OF LEARNING. JUST A QUESTION, JUST A CONSIDERATION. CTA, THEIR POSITION STATEMENT, I DON'T KNOW WHAT IT IS, BUT I KNOW IN KNOW IN ORANGE COUNTY, THEY ALMOST WENT THROUGH THE ROOF BECAUSE THE AVERAGE AMOUNT OF FAMILY GROUP INSURANCE WENT UP FROM 1,325 FROM 1,325 TO 3,159 DOLLARS IN 2024. HOW THEY GOT IT PASSED THROUGH BARGAINING IS, AS WE ALL BARGAINING IS, AS WE ALL KNOW, ORLANDO HAS BEEN VERY -- I MEAN ORANGE ORANGE COUNTY HAS BEEN VERY SUCCESSFUL AT SUCCESSFUL AT REFERENDUMS. THEY WERE ABLE TO HAVE EVEN THOUGH THERE WAS A HIGHER COST TO THE FAMILIES, THEY WERE ABLE TO TO MITIGATE IT WITH THE REFERENDUM FOR HIGHER PAY FOR THE TEACHERS. SO IT WORKED OUT. THAT IS THE SAME WITH BROWARD AND MANY OF THE SELF-INSURED COUNTIES ON PAGE 7. THEY ABSOLUTELY HAVE REFERENDUMS TO MAKE UP THE HIGHER COST ON GROUP INSURANCE AND FAMILY INSURANCE. THIS IS IMPORTANT. THE COST TO THE DISTRICT OF SIMILAR SIZE, SIMILAR SIZE, WHEN YOU COMPARE THE BROWARD, ORANGE THE BROWARD, ORANGE COUNTY, DUVAL, THOSE AMOUNT DUVAL, THOSE AMOUNT OF STUDENTS AND STAFF, AND IT'S NEARBY US, UP TO $65 MILLION MORE, AND THIS IS BECAUSE OF THE HIGH COST CLAIMANTS. WE'RE NOT DEALING WITH -- SORRY, EVERYBODY -- WE TRY TO THINK WE'RE ALL HEALTHY BUT OUR CLIENTELE, OUR STAFF ARE CLIENTELE, OUR STAFF ARE NOT IN THE MOST PHYSICALLY FIT SITUATION. WE HAD WE HAD COVID, WHICH DRAMATICALLY INCREASED SERIOUS HIGH-COST CLAIMS. WE HAVE A RAISED AMOUNT OF ASTHMATIC, DIABETES, HEART. WE HAVE REAL HEALTH CONDITIONS. WE COULD TAKE THAT APART. BUT I THINK MOST OF US WOULD RECOGNIZE THAT. SO THE COST TO THE DISTRICT, IT WILL COST BECAUSE YOU'RE GOING TO HAVE, IN MY VIEW, A MORE OF A HIGH-COST CLAIMANT. BUT THAT'S TO BE EITHER BUT THAT'S TO BE EITHER WAY. I'M TRYING TO BE -- I'M OPEN TO BOTH SIDES. LITTLE BIT OF DEVIL'S ADVOCATE. PASCO COUNTY, AND PASCO COUNTY, AND WE VISITED DEB PEPE AND DR. PEPE AND DR. WHELAN, WE WENT TO PASCO COUNTY TO SEE WHAT THEIR SELF-INSURED WAS LIKE BECAUSE THEY HAD WELL-BEING CLINICS WITH FULL RANGE OF FULL RANGE OF DOCTORS, NURSES -- NOT NOT MRI -- THEY HAD THE X-RAY MACHINES. THEY WERE FULL FACILITY. AND THOSE ARE BUILDINGS. NOW, JUST RECENTLY, THE NOW, JUST RECENTLY, THE CIT TAX WENT FROM 25 TO 5 PERCENT. SO OUR AMOUNT OF CAPITAL SO OUR AMOUNT OF CAPITAL FUNDS TO TO BUILD CLINICS IS TREMENDOUSLY, IN MY TREMENDOUSLY, IN MY REVIEW, IS GOING TO BE SLIGHTED. SO WILL WE HAVE CLINICS? WILL WE HAVE THE WILL WE HAVE THE ONE-STOP SHOPS? MAYBE FOUR OR FIVE YEARS, BUT EVERY ONE OF US KNOWS THAT IF WE DON'T GET A DON'T GET A MILLAGE PASSED FOR OUR STAFF, WE'RE LOOKING AT INCREASED COSTS SELF-INSURED. AGAIN, I'M PUTTING IT DOWN FOR THE HIGH-COST CLAIMANTS BECAUSE THAT'S GOING TO BE WHAT WE HAVE IN REALITY. LAST, MY LAST, MY POINT WOULD BE -- AND I KNOW, SUPERINTENDENT AYRES, YOU WANT SOME TYPE OF CONSENSUS, TRACY, YOU WENT AHEAD AND GAVE ME A FEW STATEMENTS. WHAT IS YOUR FIRST NAME? SO SORRY? LORI. YOU GAVE US THE YOU GAVE US THE CHOICES. WE DON'T HAVE TO SAY YES SELF-INSURANCE THIS 2026. WE DON'T HAVE TO SAY LET'S STAY WITH AETNA. BUT WHAT WE COULD SAY, WHAT WE COULD HAVE CONSENSUS, AND TRACY, WOULD YOU GO AHEAD AND RESTATE WHAT WE COULD DO? >> SURE. BEFORE YOU TODAY WE WOULD LIKE TO KNOW DIRECTION ON WHETHER WE WOULD BE SELF FUNDED OR FULLY INSURED? '26. SHOULD YOU -- OH, SORRY. PABLO. SHOULD I START AGAIN? HELPING US TODAY TO DECIDE IN 26 WHETHER SELF-FUNDED OR FULLY INSURED. SHOULD WE GO THE SELF-FUNDED ROUTE, THE QUESTION WILL BE, SHOULD WE GO AHEAD AND STAY WITH AETNA TO KIND OF HAVE IT BE A SMOOTHER PROCESS FOR OUR EMPLOYEES WHILE WE'RE CUTTING OUR TEETH ON IT OR SHOULD WE GO OUT TO BID AND PERHAPS CARVE THINGS OUT AND MAYBE FIND A DIFFERENT CARRIER ALTOGETHER IN '26. WE'RE HAPPY TO DO WHATEVER IT IS YOU GUYS WOULD LIKE. WE WANT TO HELP YOU FEEL GOOD ABOUT WHAT THE DECISIONS ARE. I WOULD SAY EVERYTHING YOU JUST SAID IS RIGHT ON, SPOT ON. WE DO HAVE WE DO HAVE HIGH-COST WE DO HAVE HIGH-COST CLAIMANTS. WE'LL CONTINUE TO HAVE HIGH-COST CLAIMANTS AND HAVE THEM IN '26 WHETHER FULLY INSURED OR SELF FUNDED. THE DIFFERENCE IS WE WON'T HAVE RATE CAPS LOCKED IN. WE KNOW AETNA, WE APPRECIATED OUR TIME WITH AETNA AND LIKE WORKING WITH THEM. THEY HAVE LEARNED WE ARE EXPENSIVE. WE'RE GOING TO BE PAYING EITHER WAY. THE QUESTION IS DO WE WANT TO PAY THEM AND HOPEFULLY THAT COVERS EVERYTHING, MAYBE WE WANT TO PAY IT OURSELVES. IF WE DO BETTER WE SAVE A LITTLE MONEY. >>Lynn Gray: >>Lynn Gray: YEAH, I THINK -- DELAYED PROCESS. TO MAKE A DECISION IN MY VIEW, BECAUSE WE HAVE A LOT OF THINGS GOING ON WITH MILLAGE, YES OR NO, THE REALITY OF OUR CIT IS DEFINITELY A BIG CAPITAL FUNDING IF YOU WANT TO BUILD CLINICS, THAT'S ANOTHER AREA. BUT THE POINT IS, WHEN YOU COMPARE OTHER DISTRICTS, OH, THEY ARE ALL THEY ARE ALL SELF-FUNDED, THOSE DISTRICTS HAVE RECEIVED SOME OF THEM TWO REFERENDUMS FOR STAFF SALARIES. WE HAVE RECEIVED WE HAVE RECEIVED ZERO. SO BEFORE WE GET INTO THIS HIGH IDEA, OH, WE'LL SAVE ALL THIS MONEY AND, YES, I RECOGNIZE AETNA WILL PROBABLY GO UP 3 TO 4 PERCENT, POSSIBLY, YOU THINK, RIGHT? >> YEAH, PROBABLY A ZERO BEHIND THAT. >> 10%. >> MAYBE, YEAH. >>Lynn Gray: 10%. ALL RIGHT. ALSO REFLEX RISING HEALTH CARE. RISING COSTS. I DON'T HAVE TO TELL ANYBODY THAT. IT'S HUGE. BUT THAT IS THE SAME, IT HOLDS TRUE WITH TRUE WITH SELF-INSURED. SO WHAT I WANT TO SAY IS BEFORE WE JUMP THE GUN AND I THINK EVERY ONE OF US CAN VISIT DISTRICTS WHO HAVE SELF-INSURED AND SEE AND SEE THE BUILDINGS THAT THEY HAVE. IT'S A LOT DIFFERENT AND OUR AVAILABLE MONEY TO DO AVAILABLE MONEY TO DO THAT IS JUST IN MY VIEW -- I KNOW WE HAVE A FUND BALANCE OF 14, 19 PERCENT, BUT THAT WILL ERODE THAT FUND BALANCE WHEN WE START LOOKING AT IT, IF YOU'RE TALKING 65 MILLION AND THAT 65 MILLION AND THAT IS ORANGE COUNTY, BUT REPLACING IT WITH A REFERENDUM FOR TEACHERS WITH A SALARY. SO THERE IS A LOT, SO THERE IS A LOT, TO ME, WE'LL GET EXCITED, GET EXCITED, SELF-INSURED, AND WE SHOULD, BECAUSE WE'RE HEARING FROM FROM EXPERTS, BUT WE HAVE TO TEMPER IT WITH TEMPER IT WITH OUR ABSOLUTE FISCAL REALITY, NOT THIS YEAR, BUT THE FUTURE. WE'RE NOT IN THE BEST PLACE. SO THAT'S MY COMMENTS. THANK YOU, MEMBER VAUGHN. >>Jessica Vaughn: THANK YOU, MEMBER GRAY. DR. VAUGHN. -- DR. HAHN. >>Stacy Hahn: MINE IS ABOUT FINANCES. WE TALKED ABOUT THIS BEFORE, A FEW OF US ON THIS BOARD HAVE SAT THROUGH THIS PRESENTATION OVER THE LAST SIX TO TEN YEARS. MANY A FEW TIMES. I DO WANT TO MOVE TOWARD THIS. I WANT US TO BE FINANCIALLY SET UP TO DO THIS. MY QUESTION IS MY QUESTION IS AROUND THE RESERVES THAT BY STATE LAW WE HAVE TO HAVE. I SEE I SEE HERE TWO BULLET POINTS. HAVE TO BUILD ADDITIONAL RESERVE EQUAL TO TWO MONTHS OF EQUAL TO TWO MONTHS OF CLAIMS, $48 MILLION WE'RE LOOKING AT CAN BE BUILT UP OVER THREE YEARS, APPROXIMATELY 16 MILLION A YEAR. I NEED TO SEE A PLAN FOR THAT, LIKE, WHAT ARE YOU GOING TO CHANGE IN THE WAY WE SPEND MONEY TO SAVE THAT MONEY? TO SAVE $16 MILLION. SO I WOULD LIKE TO SEE SOME TYPE OF FINANCIAL SAVINGS PLAN, WHETHER IT BE, LOOK, WE KNOW WE ARE VERY HEAVY ON EMPLOYEES OUTSIDE THE SCHOOLHOUSE. ARE YOU PLANNING TO MAKE SOME CUTS TO SAVE? WHERE IS THE SAVINGS GOING TO COME FROM? I THINK THAT IS AN IMPORTANT QUESTION FOR ALL OF US. WHERE IS IT GOING TO HIT US? I DO THINK THAT WE'RE GOING TO SEE PREMIUMS CONTINUING TO RISE DRASTICALLY EVERY YEAR. I THINK THE ONLY WAY TO CONTROL THAT COST FOR EMPLOYEES IS HAVING SOME TYPE OF FLEXIBILITY TO DO TO DO THAT. RIGHT NOW, WE RIGHT NOW, WE DON'T. WE DON'T HAVE THAT. AND WITH EVERYTHING BEING SO EXPENSIVE RIGHT NOW IN OUR COUNTRY, FROM FOOD TO COUNTRY, FROM FOOD TO HOUSING. THE COSTS ARE THE COSTS ARE ASTRONOMICAL. PEOPLE CAN'T AFFORD TO EAT AND THEY ARE NOT GOING TO CONTINUE TO AFFORD TO TAKE CARE OF THEIR HEALTH. SO WE NEED A MECHANISM. I JUST SEE THIS AS I JUST SEE THIS AS A MECHANISM TO BE ABLE TO DO SOMETHING POSITIVE FOR OUR EMPLOYEES. THERE ARE LOTS OF IN THE WEEDS CONVERSATIONS WE CAN HAVE, BUT THE FINANCIAL PIECE FOR ME FOR THE HEALTH OF THIS DISTRICT AND THE FINANCIAL HEALTH OF OUR EMPLOYEES IS PRIORITY. BUT I DO BUT I DO HAVE A QUESTION. IS THERE EVER A POINT IN TIME WHERE A CLAIM COMES TO THE BOARD TO DECIDE WHETHER OR NOT IT IS TO BE PAID? >> THERE ARE PROBABLY DISTRICTS THAT HAVE WHAT THEY CALL AN INSURANCE COMMITTEE THAT WOULD HANDLE THAT TYPE OF THING. SO IT WOULD JUST DEPEND ON HOW YOU STRUCTURE IT. BY ALLOWING, IF YOU BY ALLOWING, IF YOU PAY THAT ADDITIONAL ADMIN COST TO HAVE THE CARRIER DO IT, THE CARRIER DO IT, THEN THEY WOULD BE WORKING THAT FOR WOULD BE WORKING THAT FOR YOU. BUT ULTIMATELY YOU COULD MAKE IT -- YOU WOULD BE THE FINAL SAY AS A DISTRICT, BUT YOU CAN STRUCTURE THAT ANY WAY YOU WANT TO. SO IT DOESN'T NECESSARILY -- >>Stacy Hahn: NOTHING IN STATE STATUTE, MR. PORTER, THAT SAYS A BOARD ULTIMATELY WILL DECIDE IF A CLAIM IS PAID. >>Jim Porter: YOU'RE NOT REQUIRED TO DO THAT, NO. >>Stacy Hahn: I AM NOT A HEALTH CARE PROVIDER. I DON'T WANT TO START MAKING DECISIONS AROUND -- >>Jim Porter: AVOID HAVING THE BOARD PUT IN THAT POSITION. >> THE INSURANCE COMMITTEE AS WELL. WE WOULD WANT TO AVOID THAT ALTOGETHER. I THINK IT WOULD MAKE SENSE. WE WOULD DO IT COLLABORATIVELY BUT IT SEEMS WE WOULD WANT TO PAY A COMPANY TO DO THAT. >>Stacy Hahn: YEAH, I THINK, YOU KNOW, SEEING -- I KNOW, SEEING -- I AM CONCERNED ABOUT THE RISK IN THIS. WE DISCUSSED IT ESPECIALLY DURING COVID WHEN A LOT OF DISTRICTS WERE SEEING DISTRICTS WERE SEEING THEIR CLAIMS SKYROCKET. SO I AM CONCERNED ABOUT THAT RISK, BUT I GUESS THAT IS THE STOPGAP INSURANCE CAN HELP MITIGATE THAT RISK. SO THAT'S SOMETHING I WOULD, IF SOMETHING IS BROUGHT TO THE BOARD, I WOULD WANT TO BOARD, I WOULD WANT TO SEE IN A PROPOSAL. I WOULD WANT TO SEE AN OUTSIDE ADMINISTRATOR IN THAT PROPOSAL. I DON'T WANT TO HAVE TO HIRE A WHOLE NEW DIVISION OF EMPLOYEES AND START BECOMING A SMALL -- AND I JUST -- I DON'T KNOW HOW OTHER BIG DISTRICTS HANDLE OTHER BIG DISTRICTS HANDLE THAT, IF THEY HAVE LARGE -- IF THEY HAVE LARGE -- LIKE NOW THEY HAVE 25, 30 MORE EMPLOYEES AND THEY ARE BASICALLY OR IF THEY ARE PAYING A FEE TO HAVE SOMEBODY HANDLE LIKE THE CLAIMS LIKE WE TALKED ABOUT. WHAT ARE OTHER BIG DISTRICTS DOING AROUND THAT? ARE THEY PAYING SOMEONE TO DO THEIR CLAIMS OR HANDLING IT IN-HOUSE? >> IT VARIES, BUT THE MAJORITY CHOOSE TO HAVE AN OUTSIDE VENDOR DO THAT FOR THEM SIMPLY BECAUSE IT IS AN EXPERTISE THAT YOU WANT TO HAVE SOMEONE WHO IS USED TO DOING THAT AND KNOWS HOW TO DO THAT AND CAN GO BACK TO THE CARRIER AND SAY, WAIT A CARRIER AND SAY, WAIT A MINUTE, THIS IS WHAT WAS AGREED UPON IN THE FEE SCHEDULE BUT THIS IS WHAT WAS CHARGED AND WE WANT THE MONEY BACK AND BE ABLE TO GO DO THAT. THAT IS SOMETHING WE'D WANT TO HAVE AN EXPERT DO. >>Stacy Hahn: MY LAST QUESTION IS MORE AT A PATIENT OR AN EMPLOYEE LEVEL. WHEN WE TALK ABOUT WHEN WE TALK ABOUT BUNDLING PROCEDURES AND KEEPING COSTS LOW BY PUSHING PEOPLE TO CERTAIN DOCTORS, I HAVE A DOCTORS, I HAVE A PPO BECAUSE I HAVE DOCTORS THAT I'VE HAVE DOCTORS THAT I'VE SEEN FOR DECADES. ARE YOU TELLING ARE YOU TELLING ME IN A VEILED WAY THAT I'M GOING TO LOSE FREEDOM OF CHOICE IN MY HEALTH CARE PROVIDERS? BECAUSE THAT'S BECAUSE THAT'S LIKE A BIG INCENTIVE. I WILL PAY MORE TO BE ABLE TO CHOOSE AND KEEP MY DOCTORS. I GOT CAUGHT UP, YOU KNOW, HERE WHERE I LOST MY CARDIOLOGIST WHEN WE CHANGED CARRIERS. FOR ME, I MEAN, IT'S A LOT TO GO THROUGH TO CHANGE DOCTORS. IT JUST IS. IT'S STRESSFUL AND YOU HAVE SOMEONE YOU SOMEONE YOU TRUST. SO WILL WE SO WILL WE LOSE THAT ABILITY AS PATIENTS? >> SO THAT'S WHERE YOU DECIDE IF THE PROGRAM IS EITHER THE PROGRAM IS EITHER VOLUNTARY OR MANDATORY. ESPECIALLY AS YOU'RE ESPECIALLY AS YOU'RE STARTING THE PROCESS, YOU WOULD MORE THAN LIKELY CHOOSE FOR LIKELY CHOOSE FOR IT TO BE VOLUNTARY. THERE ARE WAYS TO STEER USING BENEFIT DESIGNS. YEAH, THE INTENT WOULD NOT BE TO TAKE THAT AWAY. >>Stacy Hahn: WHEN YOU SAY THINGS LIKE STEER, THAT MEANS YOU'RE GOING TO MANIPULATE -- YOU'RE GOING TO RESTRICT MY ABILITY TO CHOOSE. >> NO, NO. >>Stacy Hahn: JUST BE CAREFUL WITH THOSE WORDS. >>Jim Porter: THE QUESTION WAS A VERY SPECIFIC QUESTION AND WE NEED A VERY SPECIFIC ANSWER TO THE QUESTION. I THINK THAT IS IMPORTANT FOR EVERYONE TO HEAR. IF YOU COULD MAYBE REPEAT THE QUESTION. >>Stacy Hahn: SO THE DISTRICT WOULD DECIDE IF WE'RE VOLUNTARY OR MANDATORY. >> YES. >>Stacy Hahn: OBVIOUSLY, WHEN YOU'RE GOING FROM ONE SYSTEM THAT'S BEEN IN PLACE SINCE THE BEGINNING OF TIME IN THIS DISTRICT, TO SOMETHING DISTRICT, TO SOMETHING NEW, YOU CERTAINLY WOULD NOT WANT TO MAKE THINGS MANDATORY BECAUSE CHANGE IS HARD IS HARD ENOUGH. I JUST THINK IT'S IMPORTANT TO A LOT OF PEOPLE TO LOT OF PEOPLE TO BE ABLE TO LOT OF PEOPLE TO BE ABLE TO HAVE THAT HEALTH CARE FREEDOM TO CHOOSE CHOOSE WHAT'S BEST FOR THEM. THAT WAS A PERSONAL KIND OF QUESTION I HAD. I'VE BEEN THROUGH IT. IT'S BEEN ROUGH TO MAKE THOSE TRANSITIONS. >> IT'S NOT OUR INTENT TO DO THAT. WE HAVE AN INSURANCE COMMITTEE THAT'S MADE UP OF UNIONS AND THEY ARE GOING TO PROTECT THEIR FOLKS JUST LIKE WE WOULD PROTECT -- AND ALL AROUND THE TABLE ALL HAVE THE SAME INSURANCE. WE DON'T WANT TO RESTRICT FOLKS. BUT WHEN LORI SAYS THINGS LIKE "STEER," WE COULD CERTAINLY INCENTIVIZE FOLKS TO GO TO A BETTER PLACE. MY HUSBAND MY HUSBAND IS GETTING A COLONOSCOPY ON MONDAY, HE SAME HOME AND SAID SHOULD I DO A SURGERY CENTER OR SURGERY CENTER OR HOSPITAL? BLESS YOUR HEART, BECAUSE HE'S HEARD ME STAY WE NEED TO STEER PEOPLE TO THE OUTPATIENT. WE CAN DO THAT BY MAYBE A LOWER COPAY. SOUNDS REALLY CRAZY. MAYBE WE WOULD PAY THEM $50 TO GO THERE BECAUSE WE WOULD SAVE SO MUCH MORE BY HAVING THEM NOT DO IT AT A HOSPITAL. THOSE ARE THE THINGS THAT WE'RE TALKING ABOUT. IF WE WANT TO REALLY SAVE SOME MONEY AND MAKE SOME CHANGES, WE WOULD DISRUPT A LOT OF PEOPLE AND THAT'S REALLY, IF YOU WANT TO DO IT, WE CAN DO TO DO IT, WE CAN DO IT. BUT I DON'T THINK ANY OF US ARE INTERESTED IN THAT. WE ALL LOVE OUR HEALTH FOLKS. I THINK WE'LL START BY HOPEFULLY STEERING AND IF PEOPLE LOVE IT, THEN MAYBE THEN MAYBE THAT IN THE FUTURE IS WHERE WE GO. THERE'S NO INTENTION OF DRASTICALLY CHANGING. >> I ALSO THINK IT'S IMPORTANT TO SHARE THAT ONE OF THE THINGS WE ASKED TRACY TO DO, AS WE WENT TO AETNA FOR NEW CARRIER PROVIDER, DO A SURVEY ON HOW THAT EXPERIENCE IS BECAUSE WE WANT TO HEAR FROM THE EMPLOYEES HOW THEY ARE ENJOYING THE EXPERIENCE WITH AETNA. IF WE STAY WITH AETNA OR DON'T, IT'S ALWAYS IMPORTANT TO HEAR HOW PEOPLE ARE FEELING ABOUT THEIR EXPERIENCE SO THEN THAT WAY WE'RE NOT SAYING WE'RE DOING SOMETHING TO THEM BUT DOING IT WITH THEM AND HAVING THEM BE A PART OF IT. IT WOULD BE THE SAME APPROACH WITH THIS. NOT WE'RE GOING TO DO ANYTHING TO THE EMPLOYEES BUT THAT WE WANT TO GET FEEDBACK AND COMMUNICATE OPENLY AND EFFECTIVELY AND NOT SAY WE'RE STEERING YOU, BUT HERE ARE OPTIONS ON HOW YOU CAN HAVE BETTER HEALTH OR BETTER OUTCOME BY UTILIZING THIS OR THAT. THAT WOULD BE THE METHOD TO MOVE THIS PROGRAM FORWARD IF WE DID IT. >>Stacy Hahn: I WOULD LIKE TO SEE THAT FINANCIAL PLAN BEFORE WE MOVE FORWARD. I THINK THAT'S IMPORTANT, HOW WE'RE GOING TO SAVE THAT MONEY. THANK YOU. >>Jessica Vaughn: THANK YOU, DR. HAHN. I'M NEXT IN THE QUEUE AND I HAVE SOME QUESTIONS. BASED ON PAGE 9, IF WE WERE TO LOOKING AT LOOKING AT FULLY INSURED LOOKING AT FULLY INSURED FOR 2025 2025 AND WE DIDN'T HAVE THE 2025 AND WE DIDN'T HAVE THE LOSS RATIO INSURANCE, JUST ON THESE ESTIMATES, WE WOULD BE PAYING AN EXTRA $75 MILLION TOWARDS HEALTH CARE? IS THAT CORRECT? >> SO IN 2025, YOU WILL CONTINUE TO BE TO BE FULLY INSURED. SO YOU'RE SO YOU'RE PAYING THE SO YOU'RE PAYING THE PREMIUMS, 96 MILLION. >>Jessica Vaughn: THAT WOULD START IN 2026. >> RIGHT. >>Jessica Vaughn: SO >>Jessica Vaughn: SO THE ESTIMATE WOULD BE $11 MILLION, $12 MILLION IF WE DIDN'T HAVE THE INSURANCE? >> ARE YOU TALKING THE STOP LOSS INSURANCE? >>Jessica Vaughn: SO WE'RE SAYING IN 2026 UNDER SELF-FUNDED, THE TOTAL IN PREMIUMS WOULD PREMIUMS WOULD BE $247 MILLION. ESTIMATED THAT OUR ESTIMATED THAT OUR COSTS WOULD BE 258, WHICH IS A DIFFERENCE BE 258, WHICH IS A DIFFERENCE OF $11 MILLION. >> YES. SO REALLY THAT'S -- SO REALLY THAT'S -- THOSE ARE ALL ESTIMATES AND THEN THE IDEA WOULD BE TO TRY TO FIGURE OUT HOW TO BRING THOSE COSTS DOWN. >>Jessica Vaughn: SURE. SO WITH THE STOP LOSS INSURANCE, WE WOULD NOT BE RESPONSIBLE FOR THE $11 MILLION, LET'S SAY THIS WAS ACTUAL CASE. I KNOW IT'S ALL JUST GUESSTIMATES BASED ON WHATEVER. >> SO THAT WOULD BE IF YOU HAD AGGREGATE STOP LOSS AGGREGATE STOP LOSS COVERAGE AND USUALLY -- NOT TO GET TOO TECHNICAL -- BUT IF YOU THINK YOUR CLAIMS ARE GOING TO BE X AMOUNT, IF YOU AMOUNT, IF YOU PURCHASE AGGREGATE COVERAGE, THEN THERE IS A CORRIDOR IS A CORRIDOR WHICH WOULD BE ABOUT 25%. YOU HAVE TO GO ABOVE THE 25% BEFORE YOU ARE REIMBURSED. I'M NOT EVEN I'M NOT EVEN AWARE OF ANY LARGE EMPLOYERS THAT ACTUALLY PURCHASE AGGREGATE STOP LOSS. WHEN WE TALK ABOUT THE INDIVIDUAL STOP LOSS, THEN THAT IS BASED OFF OF EACH INDIVIDUAL HIGH-COST CLAIM. >>Jessica Vaughn: OKAY. AND THEN FOR WHEN YOU SAY THE DISTRICT IS LIABLE, DOES THAT MEAN MEAN IF THERE'S MEDICAL LAWSUITS, THE ITICATE IS LIABLE. >> NO. >>Jessica Vaughn: WHAT DO YOU MEAN BY THE DISTRICT IS LIABLE? IS. >> I MEAN FOR YOUR FINANCIALS. >>Jessica Vaughn: MEANING WE WOULD HAVE TO PAY ALL OF THE CLAIMS AND WHATNOT VERSUS THE PREMIUMS. >> YES. >>Jessica Vaughn: SO IF THERE WAS SOME KIND OF LIABILITY, THAT'S ALL WITH THE DOCTOR, THE INDIVIDUAL INSURANCE, THE INSURANCE -- I MEAN, LIKE AETNA, DO THEY HAVE LIABILITY FOR LIKE MEDICAL CLAIMS IF THERE'S MALPRACTICE? HOW DOES THAT WORK WITH SELF-FUNDED VERSUS GOING WITH A CARRIER IF THERE'S SOME KIND OF LIKE ACTUAL LIKE ACTUAL MALPRACTICE OR LAWSUIT OR CLAIM IN THAT REGARD. >> I WOULD EXPECT THAT GOES >> I WOULD EXPECT THAT GOES TO THE THE ACTUAL PHYSICIAN OR FACILITY, BUT I'M NOT AN EXPERT IN THAT AREA. >>Jessica Vaughn: OKAY. WHEN YOU SAY THE WHEN YOU SAY THE TERMS LIKE CARVE OUT OUR PHARMACY BENEFITS. WHEN YOU USE THE TERM CARVE OUT, DO YOU MEAN AS OPPOSED TO USING AETNA'S PHARMACY, FIND ANOTHER PHARMACEUTICAL COMPANY, SORT OF PIECEMEAL IT TOGETHER AS OPPOSED TO FULLY USING AETNA, THAT'S WHAT CARVE OUT WOULD MEAN? >> CORRECT. >>Jessica Vaughn: ON >>Jessica Vaughn: ON TOP OF ANY -- TRYING TO GET THE RIGHT TERMS -- LOSS RATIO THAT WE WOULD INCUR, INCUR, ASIDE FROM THE ACTUAL MONEY WE HAVE TO PUT ASIDE TO START THE SELF FUNDING BY THE RATIO WHICH DR. HAHN MENTIONED MIGHT BE $48 MILLION IN RESERVES JUST TO START THE PROGRAM, THE ADDITIONAL FEES THAT WE'RE LOOKING AT ARE ON PAGE 14 HERE, WHERE WE WOULD LOOK AT OUTSIDE CONSULTING PIECES TO MANAGE ALL THIS, AND YOU MENTIONED ACTUARIAL SERVICES, DATA ANALYSIS, PHARMACY SERVICES, LEGAL CONSULTING, ALL OF THESE SIX ARE OTHER CONSULTANT AGENCIES THAT WE WOULD HAVE TO HIRE ADDITIONALLY. >> AON IS YOUR CONSULTANT TODAY. WE ARE ALREADY WE ARE ALREADY PROVIDING THESE SERVICES. SO WHETHER YOU ARE FULLY INSURED OR SELF-FUNDED IT'S JUST THAT IF YOU ARE FULLY YOU ARE FULLY INSURED, UNDER ACTUARIAL, THERE ARE ADDITIONAL THINGS WE WOULD BE DOING. BUT THOSE THINGS ARE ALREADY IN PLACE TODAY. >>Jessica Vaughn: OKAY. THIS SLIDE WAS TO HIGHLIGHT THE THINGS THAT YOU ARE PROVIDING FOR US. >> RIGHT, VERSUS THE DISTRICT'S RESPONSIBILITIES. >>Jessica Vaughn: OKAY. IF WE WERE TO BE SELF FUNDED, AGAIN, WE WOULD LOOK AT AGAIN, WE WOULD LOOK AT THE STOP LOSS RATIO OF WHATEVER THAT IS. I KNOW YOU MENTIONED OVER A HUNDRED IS WHEN IT STARTS TO BECOME A CONCERN. I KNOW THAT WE HAVE RIGHT HERE ON PAGE 10 KIND OF AN OUTLAY OF WHAT THAT LOOKS LIKE. WHAT PERCENTAGE UNDER 2026 IS THAT OF THAT OF THE THAT OF THE STOP THAT OF THE STOP LOSS? >> SO THERE ARE TWO DIFFERENT THINGS. I BELIEVE YOU'RE TALKING ABOUT THE LOSS RATIO. >>Jessica Vaughn: WHY DO I KEEP USING STOP? I THINK YOU DID THAT, DR. HAHN. >> SO WOULD NEED TO CALCULATE IT, BUT THE STOP LOSS WOULD BE THE DIFFERENCE BETWEEN YOUR ACTUAL CLAIMS AND WHAT YOU BUDGET. >>Jessica Vaughn: OKAY. >> SO IF YOU WERE JUST PICKING ROUND NUMBER, IF YOU WERE BUDGETING $250 MILLION, BUT YOUR TOTAL COSTS TOTAL COSTS CAME IN TOTAL COSTS CAME IN AT 255, THEN WHATEVER THAT WHATEVER THAT PERCENTAGE DIFFERENCE WOULD BE. I'D HAVE TO I'D HAVE TO CALCULATE IT. >>Jessica Vaughn: OKAY. I'LL GET MORE DETAILS ABOUT THAT. I JUST WANT TO, ONE, I WANTED TO SAY BEFORE I EVEN STARTED MY QUESTIONS, MY LENS OF ALL OF MY QUESTIONS AND WHAT WILL HELP ME MAKE A DECISION JUST IN GENERAL IS OBVIOUSLY WHETHER IT IS FEASIBLE AS A DISTRICT FINANCIALLY. THAT'S OUR NUMBER ONE PRIORITY AS BOARD MEMBERS BUT ULTIMATELY ALSO ACCESS TO SERVICES FROM OUR EMPLOYEES AND AFFORDABILITY AS WELL. AS A AS A DISTRICT, AS A DISTRICT, WE CONSISTENTLY TALK ABOUT WHEN WE TALK ABOUT TEACHER SALARY AND TALK ABOUT EMPLOYEE PAY ONE OF THE PIECE WE DON'T TALK ABOUT ARE THE BENEFITS AND WHAT THAT LOOKS LIKE. THAT IS A HUGE DRAW FOR PEOPLE TO WORK IN OUR DISTRICTS WHEN TALKING ABOUT SALARIES ARE THE BENEFITS THEY GET. THAT'S GOING TO BE, AGAIN, THAT'S GOING TO BE, AGAIN, ONCE WE TALK ABOUT WHETHER IT'S FEASIBLE AND FINANCIALLY CAPABLE AS AS A DISTRICT WHITE WHOLE LENS WILL BE ACCESS AND EASE FOR EMPLOYEES. I'M NOT GETTING A CLEAR UNDERSTANDING. I'M HEARING WE'RE TALKING ABOUT HOW TO INCENTIVIZE AND DRIVE EMPLOYEES TO MAKE DIFFERENT DECISIONS BUT I'M ALSO HEARING LIKE SOME OF THE MORE LONG-TERM SOLUTIONS MIGHT CAUSE CONCERN BECAUSE THEY BECAUSE THEY MIGHT LIMIT ACCESS SIMILAR TO DR. HAHN'S CONCERNS OR ONLY PROVIDE ONE AVENUE IF WE'RE TALKING ABOUT BUNDLING SURGICAL PROCEDURES OR DIFFERENT THINGS FOR OUR EMPLOYEES. I WOULD LIKE MORE OF AN UNDERSTANDING OF WHAT THAT LOOKS LIKE HONESTLY AS WELL. I'M NOT NECESSARILY PREPARED TO MAKE A DECISION. I KNOW YOU'RE LOOKING FOR DIRECTION TODAY AND I APPRECIATE THIS, BUT THIS IS THE FIRST TIME WE'VE REALLY TALKED ABOUT A LOT OF THIS IN-DEPTH INFORMATION MORE SPECIFICALLY WHAT THAT LOOKS LIKE EVEN THOUGH YOU GUYS MIGHT HAVE SAT BEFORE IT, I HAVEN'T. IT WILL TAKE ME A LITTLE WHILE TO PROCESS AND A LOT OF QUESTIONS THAT I HAVE AFTERWARDS THAT IF THEY ARE NOT ANSWERED TODAY DUE TO TIME OR AS I'M THINKING ABOUT THEM THEY COME UP, I'D LIKE MORE ANSWERS. I WANT TO BE CLEAR I KNOW YOU'RE LOOKING FOR DIRECTION BUT I'M NOT HUNDRED PERCENT READY TO GIVE THAT TODAY. MY MY LAST FINAL KIND OF UNDERSTANDING OF THIS IS WHILE IT MIGHT COST US MORE NOW, RIGHT, AS FAR AS HAVING THE RESERVES AND MAYBE WE HAVE TO HANDLE THE DIFFERENCE BETWEEN THE PREMIUMS AND THE THE PREMIUMS AND THE CLAIMS, THE HOPE IS THAT THE RISING COST IN NEXT YEAR IS GOING TO BE MITIGATED AND SMALLER. THAT'S WHY WE WOULD CHOOSE SELF-FUNDING? WHEN WE LOOK AT AETNA AND LOOKING AT 10 TO 12 PERCENT INCREASE, IF WE'RE SELF-FUNDED, THOSE INCREASES WOULD COME DOWN THE LINE ARE GOING TO BE LESS EXPENSIVE IF WE PUT IN SOME OF THESE AREAS TO DRIVE OUR EMPLOYEES TO MAKE BETTER HEALTH CHOICES NOW. >> RIGHT. SO THAT WOULD BE THE SO THAT WOULD BE THE INTENT. SO WHEN YOU'RE FULLY INSURED, YOU DON'T HAVE THOSE OPTIONS. YOU HAVE YOUR BENEFITS THAT ARE IN PLACE, WHICH IF YOU ARE SELF FUNDED THOSE BENEFITS CAN LOOK IDENTICAL. THE DIFFERENCE WOULD BE YOU'RE LIMITED UNDER A LIMITED UNDER A FULLY INSURED PLAN WHAT YOU CAN DO TO ACTUALLY BRING TO YOUR EMPLOYEES IN ADDITION TO WHAT THE CARRIER OFFERS. SO BY BEING SELF SO BY BEING SELF FUNDED, THERE ARE CERTAIN THINGS THAT ELIMINATING THAT STATE TAX, SO ADMINISTRATIVELY YOU'RE ALREADY SAVING MONEY THERE AND THEN ALSO RETAINING THE REBATES UNDER RETAINING THE REBATES UNDER YOUR PRESCRIPTION DRUG PROGRAM. BUT YOUR CLAIMS ARE STILL YOUR CLAIMS, AND THERE'S STILL A VERY LARGE PORTION OF YOUR TOTAL COST. SO BEING SO BEING SELF-FUNDED, AT LEAST YOU HAVE OTHER PROGRAMS THAT YOU CAN CONSIDER AND PUT IN PLACE AND AND OFFER TO YOUR EMPLOYEES SHOULD SHOULD THEY CHOOSE TO ACCEPT THEM, THAT WOULD HELP TO MITIGATE THE RISING COSTS OF YOUR PLANS. AT THE SAME TIME, YOU'RE TRYING TO MAKE YOUR EMPLOYEES HEALTHY. THAT'S REALLY WHAT YOU'RE TRYING TO DO. SO YOU'RE GIVING THEM BETTER OPTIONS TO TRY TO IMPROVE ON THEIR HEALTH. >>Jessica Vaughn: IF THEY CHOOSE NOT TO FOLLOW THOSE, ARE WE PENALIZED? ARE THEY PENALIZED? IS EVERYONE PENAL RIDES? IS IS -- PENALIZED? IT COSTS US MORE IN CLAIMS OR THEIR PREMIUMS GO THEIR PREMIUMS GO UP. IF THEY DON'T MAKE THOSE HEALTHY CHOICES, WHO IS PENALIZED FOR THAT? >> THEN THE CLAIMS >> THEN THE CLAIMS ARE STILL >> THEN THE CLAIMS ARE STILL THE CLAIMS -- >>Jessica Vaughn: WE'RE ALL PENALIZED. WE PAY MORE AND MAYBE WE HAVE TO RAISE THEIR PREMIUMS. AM I UNDERSTANDING THAT CORRECTLY? >> THINK OF THE EXAMPLE OF MY HUSBAND AND HIS HUSBAND AND HIS COLONOSCOPY, LOVE HIM TO GO TO AN OUTPATIENT WHERE IT COSTS LESS, BUT IF HE DOES IT AT THE HOSPITAL, THE CLAIM WILL COST MORE. HOW DOES THAT HURT ALL OF US? WHEN IT'S TIME FOR RENEWALS AND LOOKING AT NEXT YEAR AND COUNT ON THE FACT THAT'S PROBABLY GOING TO GO TO THE HOSPITAL AGAIN. WHEN YOU'RE FULLY INSURED, THE HEALTH CARRIER YOU ARE WITH IS WATCHING ALL THIS AND GOING, HUH, OKAY, WE GOT YOU AND GREAT RENEWAL FOR '25, BUT WE'RE SEEING THAT YOU GUYS LIKE TO GO TO THE HOSPITAL AND WATCH THE COMMERCIALS ON TV WHERE IT SAYS ASK YOUR DOCTOR, YOU ASK THE DOCTOR AND YOU END UP WITH MORE MEDICATION. NOW THE HEALTH INSURANCE CARRIER IS SAYING WHEN WE RENEW IN '26, WE'RE GOING TO PLAN FOR THAT. WE'RE GOING TO SEE A LARGE INCREASE. I'M NOT THINKING 10. I'M THINKING MAYBE 30. IT COULD BE SOMETHING REALLY BIG. IF WE'RE GOING TO PAY MORE, THEN MAYBE IT'S TIME FOR US TO PLAN ON PAYING WHATEVER IT IS. BECAUSE THE CARRIER NEEDS -- THEY NEED TO RUN. THEY CAN'T HAVE 100 PERCENT. THEY NEED IT IN THE '90s. LOVE IT IN THE '80s BECAUSE THAT MEANS ALL THAT MONEY THAT'S NOT NOT USED, THEY CAN PAY FOR THEIR COMPANY AND PAY FOR THE DOCTORS AND ALL THAT GREAT STUFF. IF WE DON'T DO THIS, WE'RE GOING TO PAY THEM FULLY INSURED AND THEY'LL HAVE TO PAD IT, FOR LACK OF A BETTER WORD, BECAUSE THEY HAVE TO RUN THEIR BUSINESS. IT'S KIND OF LIKE WE'RE IT'S KIND OF LIKE WE'RE CUTTING THE CORD. SO THEIR SPECTRUM WHERE THEY GET HBO, SHOWTIME AND ALL THAT GOOD STUFF AND WE REALIZE WE DON'T REALLY WATCH THAT, WE'LL DO DIFFERENT THINGS, BUT YOU'VE GOT TO BE SELF-FUNDED IN ORDER TO DO THAT. >>Jessica Vaughn: I'M NOT GOING TO ASK THESE QUESTIONS NOW BECAUSE I'M SURE WE HAVE A LOT OF MEMBERS WITH QUESTIONS AND ONLY SO MUCH TIME. IF I WERE TO GET BACK IN QUEUE OR AFTER THIS QUESTIONS I STILL HAVE, I WOULD LIKE A COMPARISON OF THE OTHER DISTRICTS OF HOW MUCH THEY ARE PAYING OVER, WHETHER OR NOT, IF WHETHER OR NOT, IF YOU'RE TALKING ABOUT HUNDRED PERCENT, IF WE HAVE ALL THESE DISTRICTS HERE, HOW MUCH DO THEY END UP PAYING OVER OR ARE THEY NOT PAYING OVER IN THE LAST FEW YEARS. IF WE'RE COMPARING OURSELVES TO MIAMI-DADE, WHAT DOES IT LOOK LIKE IN THEIR CLAIMS COMPARED TO THEIR PREMIUMS AND COMPARISON OF WHAT THEIR PREMIUMS ARE FOR EMPLOYEES, WHAT THEY ARE CHARGING THEM AND WHAT THAT LOOKS LIKE. ACTUAL FINANCIAL COMPARISON OF WHAT THAT LOOKS LIKE WOULD BE HELPFUL FOR ME AS WELL AS MORE OF AN UNDERSTANDING OF WHO IS GOING TO BE MAKING THE DECISIONS WHEN IT COMES TO OUR EMPLOYEES' CLAIMS. I KNOW DR. HAHN KIND OF ASKED THAT QUESTION AND WE TALKED ABOUT A COMMITTEE, BUT IF WE DON'T HAVE A COMMITTEE, STAYING WITH AETNA, OUTSOURCING THAT, AGAIN, MY CONCERN IS MAKING SURE OUR EMPLOYEES HAVE ACCESS TO THE SERVICES THAT SERVICES THAT ARE NEEDED -- THANK YOU. I LOVE HEARING MY VOICE REPEATED. IT IS MY FAVORITE THING. SO, AGAIN, TO MAKE SURE THAT WE'RE NOT HAVING CLAIMS THAT ARE BEING DENIED BY AN INTERNAL GROUP WHERE TO DR. HAHN'S POINT, PEOPLE WHO HAVE MORE EXPERTISE AT AN INSURANCE COMPANY MIGHT SEE THE NEED FOR THOSE CLAIMS. MORE OF AN UNDERSTANDING OF WHAT THAT PROCESS LOOKS LIKE AS WELL AS A COMPARISON TO OTHER DISTRICTS AND WHAT THEIR CLAIMS ARE COMPARED TO THEIR PREMIUMS AND WHAT THEIR PREMIUMS ARE. I APPRECIATE ALL YOUR TIME. SO THE NEXT IN QUEUE WOULD BE MEMBER RENDON. >>Jim Porter: I WANT TO SAY GIVE YOU A TIME CHECK. IT'S 11:00. THE MEETING IS SCHEDULED UNTIL NOON. I WANT TO MAKE YOU AWARE IT IS A LITTLE AFTER 11. >>Patti Rendon: THANK YOU. THANK YOU SO MUCH FOR THE PRESENTATION. A COUPLE OF THE QUESTIONS I HAVE ARE A LITTLE BIT HIGHER LEVEL. I APPRECIATE DR. HAHN AND MEMBER VAUGHN'S QUESTIONS BECAUSE I THINK IT DOES BRING TO A POINT TO MAKE SURE WE SEE THIS TO MAKE SURE WE SEE THIS FROM A GLOBAL POINT OF VIEW. I APPRECIATE THE FACT THAT WE LOOK AT THE OTHER DISTRICTS AND SEVERAL HAVE REFERENDUMS OR NOT. AGAIN, THOSE REFERENDUMS ARE GOING TO BE BASED ON WHATEVER THE LAW OF THAT REFERENDUM IS AND NOT DIRECTLY RELATED TO THE INSURANCE COSTS. RIGHT NOW RIGHT NOW WE'RE LOOKING AT THE FACT, FOR EXAMPLE, PASCO COUNTY, FAMILY FAMILY PREMIUMS FAMILY PREMIUMS ARE $300. SINGLE PARENT WITH TWO CHILDREN 1600 WITH AETNA AND ABOUT TO GO OVER 10% OR HIGHER. CONSEQUENTLY, EVEN IF WE LOOK AT OUR REFERENDUM OUR REFERENDUM PASSING, THE COST -- THEY ARE GOING TO BE -- THEY ARE GOING TO BE PAYING EVERY SINGLE MONTH WILL OUTWEIGH EVEN WITH THE RETURN IN THE REFERENDUM. AS AN INTERNAL DISTRICT I'M LOOKING AT WAYS IN WHICH WE CAN IMPROVE ALL BENEFITS TO ALL OF OUR EMPLOYEES TO MAKE SURE WE'RE SUSTAINING THEM AND YET NOT CUTTING THE QUALITY OF THEIR BENEFITS. THAT'S THE BIGGEST PART TO ME. WHEN I LOOK AT SELF INSURANCE, SELF INSURANCE IS SUCH A LARGE PICTURE. IT'S NOT A SIMPLE YOU EITHER HAVE AETNA OR DON'T HAVE AETNA OR YOU HAVE CIGNA OR YOU DON'T HAVE HAVE CIGNA. YOU CREATE YOUR SELF-INSURANCE AS YOU WANT IT TO BE. AND I THINK THAT IS THE KEY PLAN IN HERE IS THAT WE AS A DISTRICT ARE GOING TO CREATE A PLAN THAT'S GOING TO BE THE THAT'S GOING TO BE THE BEST FOR OUR EMPLOYEES. WE ALSO HAVE SOME WAYS OF EITHER -- NO IT WAS TO AON -- HAVING A CONSULTANT OR NOT HAVING A CONSULTANT. OBVIOUSLY, WITH NEVER GOING INTO THIS TYPE OF FIELD WE'RE GOING TO INITIALLY HAVE TO HAVE A CONSULTANT, BUT EVERY SINGLE CONSULTANT NATIONWIDE ARE GOING TO HAVE DIFFERENT BENEFITS PACKAGES THAT WE'RE GOING TO HAVE ACCESS TO. EVERY INSURANCE COMPANY THAT YOU WORK WITH ARE GOING TO HAVE ACCESS TO VARIOUS ACCESS TO VARIOUS UNDERWRITERS. THEY ARE GOING TO HAVE VARIOUS PROGRAMS IN WHICH THEY HAVE DIFFERENT RELATIONSHIPS WITH, WHICH ARE GOING TO THEN IN TURN HAVE DIFFERENT PREMIUMS -- I MEAN, DIFFERENT TYPES OF COSTS THAT WE'RE EITHER GOING TO BENEFIT FROM OR NOT BENEFIT FROM. I THINK IT'S VERY IMPORTANT AS A DISTRICT DISTRICT THAT I AM VERY MUCH WILLING AND WANT TO DO SELF INSURANCE BUT WANT TO DO IT WITH KNOWLEDGE. I THINK THAT IS A KEY THING THAT I THINK AS A BOARD WE LACK BECAUSE IT'S NOT A BECAUSE IT'S NOT A ONE-STOP SHOP. AT THE END OF THE AT THE END OF THE DAY, ION HAS RELATIONSHIPS WITH CERTAIN VENDORS THAT HAVE RELATIONSHIPS WITH OTHER VENDORS. FOR EXAMPLE, AETNA IS GOING TO HAVE CERTAIN PREMIUMS OR CERTAIN COSTS WHEN THEY WORK WITH CERTAIN HOSPITALS AND CERTAIN DOCTORS. THOSE ARE THOSE ARE PRENEGOTIATED BASED UPON WHERE THEY WORK. FOR EXAMPLE, I'LL USE CAR INSURANCE, NOT A MEMBER OF THE GAME. IF I GO TO TRIPLE A AND I'M GOING TO DO -- AND THEY GO OUT AND TAKE MY CAR AND TAKE MY CAR INSURANCE, THEY HAVE DIFFERENT RELATIONSHIPS WITH DIFFERENT UNDERWRITERS WHICH THEY CAN THEN OFFER ME A DIFFERENT COST OF MY INSURANCE. IF I GO WITH AUTO OWNERS, AUTO OWNERS WILL HAVE DIFFERENT RELATIONSHIPS. THEY CAN BOTH BE WORKING THEY CAN BOTH BE WORKING WITH THE SAME UNDERWRITER AND GIVE ME TWO SEPARATE QUOTES BASED UPON THE FACT THAT THAT PARTICULAR INSURER HAS AMOUNT OF BUSINESS WITH THAT UNDERWRITER. SAME THING APPLY TO COLUMNIST. YOU GUYS HAVE -- CONSULTANTS. YOU GUYS HAVE DIFFERENT RELATIONSHIPS WITH DIFFERENT VENDORS. AETNA, CIGNA. I PERSONALLY BELIEVE WE AS A DISTRICT HAVE TO LOOK AT A MULTI-PHASED APPROACH. WE HAVE TO LOOK WE HAVE TO LOOK AT WHICH CONSULTANTS ARE GOING TO HAVE WHICH RELATIONSHIPS WITH WHICH VENDORS AND WHAT CAN THEY BRING TO THE TABLE. ION MAY HAVE ONE RELATIONSHIP WITH AETNA. ANOTHER CONSULTANT MAY HAVE A DIFFERENT RELATIONSHIP. I DON'T THINK AS A DISTRICT WE CAN JUMP INTO THIS WITHOUT AT LEAST HAVING CONSULTANTS INITIALLY. BUT I THINK WE HAVE TO LOOK FUTURISTICALLY AT WHERE THAT COULD GO. BUT WE HAVE TO CONSULT ALL DIFFERENT AREAS TO MAKE SURE WE'RE BRINGING THE BEST PACKAGE TO OUR DISTRICT. WE HAVE SOME AREAS OUT THERE WHERE THEY WILL NOT BE CHARGING US ANY KIND OF CONSULTANT FEES, BUT THEY ARE GOING TO OFFER OUR EMPLOYEES OTHER BENEFITS, FOR EXAMPLE, EXAMPLE, AFLAC, ONE OF THE THINGS THEY OFFER US BUT NOT HAVE A CONSULTANT FEE BECAUSE THEY MAKE MONEY OFF OF THE EMPLOYEES THAT CHOOSE EMPLOYEES THAT CHOOSE AFLAC. WE HAVE TO LOOK AT EVERYTHING FROM A GLOBAL POINT OF VIEW. ALSO, EACH INDIVIDUAL CARRIER THAT WE WORK WITH WHEN WE'RE SELF-INSURED ARE GOING TO RENEGOTIATE THOSE RATES. WE'RE BASING OUR CLAIMS ON WHAT WE'RE CURRENTLY PAYING. AETNA IS CURRENTLY PAYING SO MUCH AS A PRENEGOTIATED RATE WITH OUR HOSPITALS, WITH OUR DOCTORS, BUT WHEN WE GO TO THE TABLE AS AN INDIVIDUAL TABLE AS AN INDIVIDUAL CARRIER, AS THE LARGEST EMPLOYER OF HILLSBOROUGH COUNTY, WHEN WE LOOK AT OUR INDIVIDUAL HOSPITALS AND THINGS THAT ARE HOUSED, BAY CARE, TGH, WE THEN COME TO THE TABLE AS THE LARGEST EMPLOYER OF HILLSBOROUGH COUNTY TO RENEGOTIATE WHAT AETNA RENEGOTIATE WHAT AETNA DID. SO WE LOOK -- THERE ARE SO MANY DIFFERENT LAYERS OF THIS THAT WE COULD AND COULD NOT SAVE MONEY THAT WE HAVE GOT TO MAKE SURE THAT WHEN WE GO OUT IT'S NOT A ONE-STOP SHOP. WE'VE GOT TO MAKE SURE WE DO A FULL VIEW OF ALL THE DIFFERENT POSSIBILITIES AND ALL THE DIFFERENT WAYS IN WHICH WE LOOK AT. NO OFFENSE TO AON. I KNOW YOU ARE A GREAT COMPANY AND DONE A LOT OF GREAT THINGS AND BEEN WITH OUR ORGANIZATION FOR A LONG TIME, BUT THERE ARE OTHER CONSULTANTS OUT THERE THAT HAVE OTHER RELATIONSHIPS THAT HAVE OTHER NEGOTIATED TERMS AND WE CANNOT ELIMINATE THEM FROM OTHER OPTIONS. WE ALSO NEED TO MAKE SURE WE KNOW EXACTLY WHAT THOSE OPTIONS ARE. I THINK THOSE ARE VERY CRITICAL THINGS. I ALSO WANT TO THANK AND UNDERSTAND AND MAKE SURE WE ARE VERY CLEAR THAT AS A DISTRICT WE WILL NEVER TELL ANYBODY WHAT THEIR HEALTH CARE CHOICES ARE EVER. THAT'S THAT'S SOMETHING I THINK IS PRETTY MUCH I KNOW FOR ME PERSONALLY, I SHOULD HAVE A CHOICE CHOICE TO GO TO WHATEVER DOCTOR, HOSPITAL OR FACILITY I CHOOSE TO. BUT AS AN INSURANCE COMPANY, NO MATTER WHO WE USE, WHETHER SELF INSURED OR FULLY INSURED, IT'S GOING TO BE A COST TO WHATEVER THAT IS. I MAY NEGOTIATE AS A DISTRICT WE MAY HAVE A BETTER PLAN WITH MAY HAVE A BETTER PLAN WITH TGH THAN WE DO WITH BAY CARE BASED ON WHO WE CHOOSE TO GO WITH. BASED UPON THAT I CAN STILL GO TO TGH IF I WANT BUT I KNOW I'LL HAVE A DIFFERENT DEDUCTIBLE OR I KNOW I HAVE A DIFFERENT THING. IT WILL BE MY CHOICE BUT I WILL STILL BE ALLOWED TO USE WHOEVER I I WANT. I THINK THAT'S IMPORTANT. THOSE ARE THE CHOICES WE THOSE ARE THE CHOICES WE MAKE. I AS A FAMILY MAY CHOOSE A PPO, HOW THAT HOW THAT LOOKS ON A GENERALIZED FIELD. IF I'M GIVING MY APPROVAL TO THIS SELF INSURANCE, WE HAVE TO GLOBALLY LOOK AT IT. YOU CAN'T JUST COME YOU CAN'T JUST COME IN, NO IT WAS TO AON, AND SAY THIS IS WHAT AON RECOMMENDS. THESE ARE OUR THREE PLANS BECAUSE WE ARE BECAUSE WE ARE ELIMINATING A LARGE BODY OF INSURANCE CARRIERS AND OPTIONS IN THIS COUNTRY THAT IF I GO TO THESE DIFFERENT DISTRICTS, THEY ARE ALL WORKING WITH DIFFERENT PEOPLE. AON IS NOT THE ONLY CONSULTANT THAT'S OUT THERE. SO WE HAVE TO MAKE SO WE HAVE TO MAKE SURE THAT WHOEVER, WHATEVER PLAN WE BRING TO THE DISTRICT WAS THE BEST PLAN. WE ALSO NEED TO UNDERSTAND -- I BELIEVE I'M CORRECT ON THIS, THAT WE'RE NOT GOING TO LOOK TO MAKE $50 MILLION YEAR ONE. BECAUSE WE'LL SAVE THE EMPLOYEES AND WANT TO MAKE SURE WE HAVE THE LEAST CHANGE WITHOUT LOSING ANY MONEY. AND WE COULD. I MEAN THERE'S TRULY AN OPTION TO DO THAT. THERE'S AN OPTION TO MAKE EVEN MORE THAN THAT. INITIALLY WE HAVE TO KNOW THAT WE WANT TO WE WANT TO CREATE A WE WANT TO CREATE A PLAN OVERALL, SO THIS IS NOT SOMETHING THAT IS GOING TO CHANGE OVERNIGHT. YOU HAVE MY SUPPORT TO DO THIS. WE HAVE TO MAKE SURE WE LOOK AT THIS FROM A BROAD SCOPE, BECAUSE IT'S NOT CUT AND DRY. SO THAT'S MY ONE SO THAT'S MY ONE CLAIM. THANK YOU. >> THANK YOU, MEMBER >> THANK YOU, MEMBER RENDON. MEMBER WASHINGTON. WASHINGTON WASHINGTON THANK YOU, MEMBER VAUGHN. I I HAVE A COUPLE OF I HAVE A COUPLE OF -- >>Henry "Shake" Washington: I HAVE A COUPLE OF POINTS AND NO QUESTIONS. FIRST OF ALL, WE HAVE TO HAVE A FINANCIAL PLAN BECAUSE THAT'S IMPORTANT WHEN YOU BRING SOMETHING SOMETHING LIKE THIS, HAVE SOMETHING IN PLACE, BECAUSE IF WE DON'T HAVE A PLAN THEN IT'S NOT TRANSPARENT. SECOND OF ALL, I FEEL WE SHOULD HAVE A CFO BEFORE WE GO INTO HAVE A CFO BEFORE WE GO INTO ALL OF THIS BECAUSE WE ARE NOT THAT FAMILIAR WITH THE AMOUNT OF MONEY THAT WE HAVE IN MONEY THAT WE HAVE IN PLACE. WE NEED TO HAVE A PERSON IN PLACE. I THINK THAT IS IMPORTANT TO HAVE A CFO. THE REFERENDUM, I AGREE WITH MS. GRAY. ALL OF THAT IS INVOLVED IN IT. I THINK THAT'S IMPORTANT BECAUSE WE WE HAVE MONEY INVOLVED FOR EMPLOYEES. LAST BUT NOT LAST BUT NOT LEAST, LAST BUT NOT LEAST, FREEDOM OF CHOICE. WHEREVER THEY FEEL THAT GOING. I THINK IT'S IMPORTANT FOR OUR EMPLOYEES TO FEEL THAT WE ARE BACKING THEM AND NOT PUTTING THEM INTO A LITTLE CUBBYHOLE SAYING YOU GO HERE OR YOU GO THERE. THEY GOT TO HAVE THAT FREEDOM AND THAT'S IMPORTANT. I HAVE THAT FREEDOM I HAVE THAT FREEDOM BECAUSE I HAVE MILITARY INSURANCE. THEY WANT TO FEEL COMFORTABLE. THEY ARE PROBABLY LISTENING NOW. WE WANT TO MAKE THEM FEEL COMFORTABLE, MAKE THEM FEEL LIKE WE ARE THERE FOR WE ARE THERE FOR THEM, WHICH WE ARE THERE FOR THEM, SO ARE THERE FOR THEM, SO THEY GO TO ANY DOCTOR OR PHARMACEUTICAL PERSON OR WHATEVER THEY NEED TO DO. I'M KIND OF ON THE BORDER LINE NOW. I AM. I'M ON THE I'M ON THE BORDER LINE BECAUSE I'M I'M STILL NOT CLEAR I'M STILL NOT CLEAR ON THE I'M STILL NOT CLEAR ON THE TWO COMPARABLE BECAUSE THERE ARE PROS AND CONS TO ALL OF THEM. AND I THINK YOU GAVE A GOOD EXAMPLE. BUT I'M JUST NOT READY BUT I'M JUST NOT READY YET FOR THAT. I JUST WANT TO WAIT A LITTLE WHILE LONGER UNTIL WE GET OTHER THINGS IN PLACE. I WANT TO THANK YOU BECAUSE I WANT TO THANK YOU BECAUSE YOU MADE A GREAT PRESENTATION. YOU DID A GREAT JOB. THANK YOU. THAT'S ALL I HAVE TO SAY. >>Van Ayres: WITH RESPECT TO THE FINANCIAL PLAN, WE WORKED OVER THE YEARS TO HAVE THE RESERVE TO MOVE IN THAT DIRECTION. WE'VE DONE THAT OVER THE LAST THREE YEARS TO GET THE FUND BALANCE WHERE IT IS TO MOVE IN THIS DIRECTION TO PAY MONEY FOR THIS. WE'RE GOING TO PAY IT EITHER WAY. WHEN YOU LOOK AT WHAT FULLY INSURED, YOU'RE GOING TO PAY THOSE COSTS, PAY IT UP FRONT. YOU'RE PAYING IT. EITHER WAY WE'RE PAYING THAT. WE MOVE TO SELF INSURANCE, OPPORTUNITY TO SAVE MONEY FOR THE DISTRICT AND THAT'S WHAT I'M HERE TO DO TO MAKE SURE WE HAVE MONIES THAT CAN GO TOWARDS EMPLOYEES. BUT WE'RE PAYING THAT EITHER WAY. IF WE GO TO FULLY IF WE GO TO FULLY INSURED, 2025, ANOTHER BOARD ITEM THAT WILL COME TO YOU IN JUNE -- JUNEISH, AND THERE WILL BE A COST TO THAT. IT WILL BE A LESS COST IF WE'RE IN A PLACE OF IN A PLACE OF SELF-INSURANCE. JUST AS A WHOLE, TALK ABOUT FINANCIAL PLAN, WE'RE GOING TO PAY THAT COST EITHER WAY. THIS IS AN OPPORTUNITY TO REDUCE THAT COST UP FRONT, HOLD THAT MONEY AND THEN IN THE LONG TERM BE ABLE TO SAVE MONEY FOR THE SCHOOL DISTRICT. >>Jessica Vaughn: THANK YOU. THANK YOU, MEMBER WASHINGTON. MEMBER COMBS. >>Nadia Combs: THANK YOU. I'M RIGHT THERE KIND OF IN THE MIDDLE. IT'S OCTOBER 29. WE'RE ALMOST TOWARDS THE END OF THE YEAR. I'M ALWAYS GOING TO I'M ALWAYS GOING TO TROY TO MAKE FISCALLY SOUND DECISIONS. AT THE END OF THE DAY, WE HAVE THOUSANDS OF STUDENTS WITHOUT TEACHERS. WE'RE WE'RE HEMORRHAGING TEACHERS LEFT AND. HEMORRHAGING EMPLOYEES LEFT AND RIGHT. IF THIS MILLAGE DOESN'T PASS, PEOPLE WILL CONTINUE TO GO TO SURROUNDING DISTRICTS. THAT'S A FACT. THE IDEA THAT 10,000 STUDENTS DON'T HAVE TEACHERS THAT REALLY BOTHERS ME EVERY DAY AND IT WILL BE MORE. ONE OF THE REASONS THAT A LOT OF PEOPLE WORK IN HILLSBOROUGH COUNTY OR STAY IN HILLSBOROUGH COUNTY IS FOR HEALTH INSURANCE. FOR ME, THAT'S PROBABLY ONE OF THE BIGGEST THINGS. WHENEVER ANYTHING HAPPENS IN MY LIFE, THE FIRST THING I THINK OF IS MY HEALTH INSURANCE. I'VE HAD COBRA BEFORE AND I KNOW WHAT IT IS LIKE TO PAY HUGE PREMIUMS. HEALTH INSURANCE IS PROBABLY THE MOST IMPORTANT THING. WHEN I LOOK AT NOT PAYING THE PREMIUM TAX OF 5 MILLION AND REBATES OF $22 MILLION AND IT LOOKS LIKE THERE'S GOING TO BE AN INCREASE AT LEAST OF $10 MILLION COMING MILLION COMING UP, WE HAVE TO DO SOMETHING. AS I SAID, I THINK OUR EMPLOYEES ARE THE MOST -- THAT'S THE MOST IMPORTANT THING AND SO MANY OF THEM HEALTH INSURANCE IS SO IMPORTANT. WE DO HAVE AN AGING POPULATION OF TEACHERS THAT WORK HERE. WE DON'T HAVE A LOT OF YOUNG PEOPLE WHO ARE COMING, WHO ARE SO EXCITED TO WORK IN HILLSBOROUGH COUNTY BECAUSE THEY CAN GO SOMEWHERE ELSE AND GET PAID MORE. WE HAVE TO THINK ABOUT THE COST OF THAT AGING POPULATION AS WELL. I THINK THE BIGGEST CONCERN IS HAVING SELF INSURANCE IS THE PREDICTABILITY OF COST, RISK MANAGEMENT, THE CLAIM HANDLING. FOR ME, I THINK IT SHOULD BE A GRADUAL APPROACH. WHAT I'VE LEARNED IS WHEN WE GO ALL THE WAY IN, SOMETHING LIKE I THINK IF WE DID AN AETNA SELF INSURANCE AND THEN IT GAVE US TIME TO REALLY BUILD THE INFRASTRUCTURE, TO BUILD WHAT WE NEED TO BUILD TO REALLY GO OUT TO OUR EMPLOYEES, SEE WHAT THEY NEED, DO THE SURVEYS. I THINK WHEN WE DID I THINK WHEN WE DID SYNERGY, IT WAS YEARS IN THE MAKING BUT WHEN WE MELTED IT WAS FAST AND IT WAS QUICK AND BECAUSE OF THAT THE CONSEQUENCES WERE SEVERE. I FEEL LIKE THIS IS THE SAME THING. I DEFINITELY THINK THE IDEA OF GOING TO A THIRD PARTY ADMINISTRATOR RIGHT AWAY WHEN IT'S OCTOBER 29, I THINK THAT COULD BE A DISASTER IN THE MAKING. I DEFINITELY WANT TO MOVE TOWARDS SELF INSURANCE. I WOULD LIKE TO SEE A GRADUAL APPROACH WITH APPROACH WITH AETNA, BUT I WOULD ALSO LIKE TO SEE US REALLY GOING FORWARD AND SOME OF THE THINGS MEMBER RENDON SAID, LOOKING FORWARD TO THAT. NOT JUST WE'LL WORK WITH AETNA AND THEN THAT'S IT. LET'S BE AGGRESSIVE ON SAYING HOW WE CAN GO OUT FURTHER THAN THAT AND MAYBE THE FOLLOWING YEAR OR TWO YEARS AFTER THAT DOING A THIRD PARTY. I'M KIND OF IN THE MIDDLE. I DEFINITELY THINK WHEN YOU LOOK AT THE RATES AND WHAT WILL INCREASE IN OUR INCREASE IN OUR SAVINGS, WE HAVE TO GO TOWARD SELF INSURANCE. NO QUESTION ABOUT THAT. SUPERINTENDENT, I VALUE YOU AS OUR ONLY EMPLOYEE TO TELL US THAT THAT'S WHAT YOU THINK THAT THAT'S WHAT YOU THINK IS THE RIGHT APPROACH. TRACY SHOTSBERG, I VALUE WHAT YOU'RE SAYING AND AON AS WELL, AS WELL AS WE MAY LOOK AT OUTSIDE CONSULTANTS. THERE ARE SO MANY FACTORS WE HAVE TO LOOK AT. THE FIRST THING IS LET'S MOVE TOWARD THAT DIRECTION. LET'S SEE WHAT HAPPENS AND THEN LET'S WORK VERY HARD AT MOVING EVEN MORE TOWARD THE THIRD PARTY. I FEEL LIKE AT THE OCTOBER 29, THE IDEA OF DOING SOMETHING THIRD PARTY AND GOING OUT THERE AND RESEARCHING THAT, TO ME, IT COULD REALLY BE DISASTROUS. IT REALLY COULD. I THINK IT NEEDS TO BE A I THINK IT NEEDS TO BE A GRADUAL APPROACH BUT I WANT LEAN TOWARDS SELF-INSURANCE BECAUSE I THINK FROM THAT, THAT NOTHING WILL REALLY CHANGE. THE EMPLOYEES COULDN'T FEEL THE IMPACT AND I THINK THAT IS THE MOST IMPORTANT THING IS THAT THE EMPLOYEES DON'T FEEL THE IMPACT. >>Jessica Vaughn: THANK YOU, MEMBER COMBS. CHAIR PEREZ. >>Karen Perez: THANK YOU, MEMBER VAUGHN. I HEAR A LOT I HEAR A LOT OF TALK ABOUT THE EMPLOYEES, BUT HOW MANY EMPLOYEES DO WE HAVE THAT ARE INSURING THEIR FAMILIES? >> PROBABLY 5,000 EMPLOYEES, MAYBE MORE. I CAN GET THAT FOR YOU. WE'LL GET THAT FOR YOU. >>Karen Perez: THANK YOU. ON A COUPLE OF PAGES, LIKE ON PAGE 5, ON PAGE 5, ON PAGE PAGE 5, ON PAGE 6, THERE WAS A MENTION THAT THE MENTION THAT THE CARRIER CAN DO THIS OR WE COULD PAY ADMINISTRATIVE FEE. SEVERAL TIMES THAT WAS MENTIONED. WHAT IS THAT ADMINISTRATIVE WHAT IS THAT ADMINISTRATIVE FEE? IS THIS ALTOGETHER ADMINISTRATIVE FEE ADMINISTRATIVE FEE OR IS THAT LIKE ADMINISTRATIVE FEE FOR THIS, ADMINISTRATIVE FEE FOR THAT? CAN YOU EXPLAIN THAT, PLEASE? >> SURE. IT IS BASED -- IT IS USUALLY IT IS BASED -- IT IS USUALLY A PER EMPLOYEE PER MONTH OR PER MEMBER PER MONTH. >>Karen Perez: FOR EACH CATEGORY? >> >> NO. THE ADMINISTRATION THE ADMINISTRATION IS DEFINITELY A PER EMPLOYEE A PER EMPLOYEE PER MONTH A PER EMPLOYEE PER MONTH FEE. LET'S JUST SAY IT'S LET'S JUST SAY IT'S BETWEEN 40 AND $50 A AND $50 A MONTH. AND THAT'S BASED OFF OF THE EMPLOYEES THAT ARE ENROLLED. AND THEN IF YOU WANT TO ADD AN ADDITIONAL COST FOR THEM TO ADDITIONAL COST FOR THEM TO BE THE FIDUCIARY, THEN YOU ARE TACKING ON -- GUESS -- 50 CENTS ON TOP OF WHAT YOU ARE ALREADY PAYING. BASED ON A PER EMPLOYEE PER MONTH FEE. >>Karen Perez: I KNOW YOU MENTIONED THAT IN SEVERAL AREAS. UNLESS YOU WANT TO PAY THE ADMINISTRATIVE FEE AND THEN MOVED ON TO THE NEXT PAGE, SAY UNLESS YOU WANT TO PAY ADMINISTRATIVE FEE. IT JUST SEEMS LIKE THOSE FEES CAN ADD UP. >> THEY CAN, RIGHT. >>Karen Perez: TO THE TUNE OF HOW MUCH? >> THAT'S PART >> THAT'S PART OF WHAT GETS NEGOTIATED. IT'S HARD FOR ME. I CAN'T REALLY GIVE YOU A NUMBER. WHETHER IT'S A CARRIER OR A THIRD-PARTY ADMINISTRATOR, THEY'LL HAVE THEIR OWN FEES, AND THAT'S PART OF WHAT GETS NEGOTIATED WITH THEM. >>Karen Perez: AND WHEN >>Karen Perez: AND WHEN YOU TAILOR OR DESIGN WITH FLEXIBILITY, DO YOU FLEXIBILITY, DO YOU LOOK AT CERTAIN DEMOGRAPHICS OR CERTAIN DISEASES DISEASES TO DISEASES TO TAILOR? >> YES. >>Karen Perez: OKAY. DO YOU LOOK AT THE DO YOU LOOK AT THE HIGH RATE OF INTERACTION WITH INTERACTION WITH THE DOCTORS OR CLAIMS OR WHAT DO YOU LOOK CLAIMS OR WHAT DO YOU LOOK AT? >> AS AN EXAMPLE, WE WOULD LOOK AT, AT, TAKE AT, TAKE DIABETES, AND SO WE WOULD LOOK AT THE CLAIMS' DATA BASED OFF OF THE PRESCRIPTION DRUGS THAT THEY ARE TAKING OR WHY THEY MAY BE GOING WHY THEY MAY BE GOING TO A DOCTOR, DIFFERENT DOCTOR, DIFFERENT TESTS THAT THEY ARE HAVING TO DETERMINE THE LEVEL OF DIABETES THAT'S IN YOUR PROGRAM, SAME THING COULD GO FOR HEART HEART CONDITION, AND YOU CAN TAILOR TAILOR PROGRAMS AROUND THAT. >> THE DIFFERENCE BEING THAT IS THE PLUS OF BEING SELF-INSURED IS WE WOULD LOOK AT OUR DATA AND RECOGNIZE THAT IS A NEED AND PUT IN A IN A PROGRAM. WE WOULD DIVE IN AND MEASURE AND MAKE SURE WE'RE HAVING A RETURN ON ON INVESTMENT. RIGHT NOW THE INSURANCE CARRIER IS RESPONSIBLE FOR THAT. WE'RE SURE THEY ARE DOING A GREAT JOB BUT REALLY DON'T HAVE ACCESS TO THE DATA. >>Karen Perez: THEN >>Karen Perez: THEN YOU MENTIONED ABOUT THE AMOUNT OF VISITS. SO IF WE HAVE A HIGH RATE. LET'S SAY LET'S SAY DIABETES, HEART DISEASE, KIDNEY ISSUES, AND THEY ARE GOING TO THE DOCTOR AT A HIGHER RATE THAN, LET'S SAY, SOMEONE WHO IS DOING BETTER OR TAKES GOOD CARE OF THEIR HEALTH, DOES THAT PERSON WHO IS TAKING GOOD CARE OF THEIR HEALTH, NOT SAYING THAT THE PERSON WITH DIABETES IS NOT OR BECAUSE THAT'S THAT'S ALSO SOMETHING THAT YOU'RE YOU'RE BORN YOU'RE BORN WITH OR WHATEVER. BOTH THE INSURANCE BOTH THE INSURANCE GOES UP AT THE SAME RATE OR -- >> YES. IT'S LOOKED AT COLLECTIVELY, ALL THE CLAIMS COLLECTIVELY. YOU'RE NEVER SINGLING ANYBODY OUT. YOU'RE JUST TRYING TO HELP THEM WITH WHATEVER THEIR WITH WHATEVER THEIR CONDITION. PEOPLE HAVE PEOPLE HAVE CONDITIONS. THEY CAN'T CONTROL THAT. YOU'RE TRYING TO MAKE SURE THAT THEY GET THE BEST CARE THEY CAN POSSIBLY GET. >>Karen Perez: RIGHT NOW, DOES THAT HAPPEN? >> PROBABLY ON SOME LEVEL. ON SOME LEVEL ON SOME LEVEL THERE ARE PROGRAMS THAT AETNA HAS IN PLACE TO TAKE CARE OF THAT. THIS IS TAKING IT ONE STEP FURTHER. >>Karen Perez: I'M >>Karen Perez: I'M SAYING, OUR INSURANCE INCREASED BECAUSE OF SOMEBODY ELSE'S HEALTH CONDITION? >> YOU LOOK AT YOUR TOTAL CLAIMS AND WHEN YOU COMPARE -- AND WHEN YOU COMPARE -- SO WHATEVER HAPPENS WITHIN THE YEAR, SOME YEARS YOU'LL HAVE HIGHER COST CLAIMANTS THAN IN OTHER YEARS, AND THAT'S ALL TAKEN INTO ACCOUNT WHEN PREMIUMS ARE BEING DEVELOPED OR BUDGET RATES ARE BEING DEVELOPED. >> BUT THOSE PEOPLE AREN'T CHARGED DIFFERENTLY. >> NO, NO. YOU'RE CHARGING EVERYBODY THE SAME. >>Karen Perez: THE 5 MILLION THAT WE SAVE THAT WE SAVE IN STATE TAXES, WHAT DO WE WHAT DO WE DO WITH WHAT DO WE DO WITH THAT? >> THEY PUT IT BACK >> THEY PUT IT BACK -- >>Karen Perez: REWE ROTATE IT BACK INTO THE SYSTEM. >> THAT IS A REALLY GREAT QUESTION TOO. WHEN WE HAVE GREAT YEARS WHERE WE DON'T HAVE HIGH-COST CLAIMANTS, WE SHOULDN'T GO OUT AND SPENDING. THAT'S WHEN WE SAVE OR LOOK AT OUR INNOVATIVE PROGRAMS, A NICE LEARNING TIME FOR US. GREAT YEARS, YOU STILL CONTINUE TO PUT IT AWAY AS IF WE HAD A PADLOCK ON IT. >> YOU >> YOU TALKED ABOUT INCENTIVE PROGRAMS, I THOUGHT MAYBE THAT'S WHAT WE DO WITH WHAT WE DO WITH THAT. >> I JUST WANTED TO ADD WHERE I HAVE SEEN SUCCESSFUL PROGRAMS TO WHAT YOU ALL ARE WHAT YOU ALL ARE SPEAKING TO, FOR EXAMPLE, SOMEONE WHO DOES HAVE A CHRONIC DIABETES CONDITION, CONDITION, EITHER PREDIABETES CONDITION, EITHER PREDIABETES OR ACTUAL FULL DIABETES, A PLAN SELF-INSURED, YOU CAN CREATE A PROGRAM FOR THAT INDIVIDUAL THAT THEY ACTUALLY WILL RECEIVE INFORMATION. THEY CAN GET ON THEY CAN GET ON LAVONGA WHICH IS A PROGRAM THAT IS SEPARATE AND REACH OUT DIRECTLY TO THEM, MAKE SURE THEY ARE TAKING MEDICATIONS, THEY SEE A PODIATRIST, A PODIATRIST, A CARDIOLOGIST, UROLOGIST, PEOPLE REACHING OUT TO THEM ON A REGULAR BASIS TO HELP THEM MANAGE IT AND NOT JUST SAY, OH, WE HOPE YOU'RE OKAY. COME SEE US WHEN YOU'RE SICK BUT HELP THEM STAY HEALTHY AND CONTINUE TO BE HEALTHY AS THEY GET OLDER SO THEY DON'T END UP ON DIALYSIS OR SOMETHING MORE SERIOUS. THOSE ARE THE PROGRAMS WE CAN DESIGN, IF THERE IS A HIGH POPULATION OF THAT TO SAY THIS IS ONE OF THE THINGS WE WANT TO HAVE FOR OUR EMPLOYEES. >>Karen Perez: THANK YOU. >>Jessica Vaughn: THANK YOU, CHAIR PEREZ. NOW WE'LL GO TO OUR SECOND ROUND OF QUESTIONS. DR. HAHN, YOU ARE NEXT IN THE QUEUE. >>Stacy Hahn: WHEN DO -- [INAUDIBLE] >> SELF-INSURANCE IN ITSELF IS A MOVEMENT THAT WOULDN'T BE A BOARD AGENDA ITEM. THAT WOULD BE SOMETHING I WOULD LOOK TO GET DIRECTION ON, NOT MOVE FORWARD UNLESS I GET DIRECTION TO DO SO. THE BOARD AGENDA ITEM -- THE FIRST AGENDA ITEM WOULD BE AROUND JUNE WHERE WE WOULD LOOK AT NEXT YEAR'S 2026. BOARD MEMBERS, YEAH, THE ACTUAL, DEPENDING IF WE WENT OPTION ONE OR TWO, OPTION ONE, COME JUNE 2025, WOULD BE 2025, WOULD BE A BOARD AGENDA ITEM EITHER IF WE WENT WITH OPTION ONE, AGENDA ITEM FOR AETNA, WHICH YOU WOULD SEE TWO DIFFERENT COSTS. IF WE'RE FULLY INSURED, YOU MIGHT SEE A COST AROUND, CAN WE GO, GO, LORI, PLEASE GO, LORI, PLEASE TO SLIDE TEN? THE DIFFERENCE THE DIFFERENCE THERE. TO ANSWER YOUR QUESTION, DR. HAHN, SELF INSURANCE IS NOT A DIRECT BOARD ITEM THAT I WOULD BRING TO THE BOARD. BOARD DO WE GO SELF-INSURED? NO, THAT IS AN ADMINISTRATIVE, THAT IS A DECISION I WOULD MAKE. I'M NOT GOING TO THAT UNLESS I GET DIRECTION FROM THE BOARD AS THIS IMPACTS THE BUDGET ONE WAY OR THE OTHER. THE BOARD AGENDA ITEM WOULD BE AROUND JUNE AROUND THE HEALTH CARE AREA, OPTION ONE OR OPTION TWO, THE OTHER TIMELINE IF WE CHOSE TO GO WITH A DIFFERENT CARRIER ALONG WITH A DIFFERENT THIRD-PARTY MANAGER. SO WHAT -- IN JUNE OF 2025 AND, TRACY OR LORI, IF YOU COULD HELP ME THROUGH THIS -- BOARD AGENDA ITEM IN JUNE ITEM IN JUNE OF 2025 UNDER FULLY INSURED PLAN. IF WE USE THIS EXAMPLE, DECIDED NOT GOING TO CHANGE ANYTHING, STAY FULLY INSURED IN '26, THAT BOARD AGENDA ITEM FOR AETNA WOULD LOOK LIKE APPROXIMATE WHAT COST, USING THE NUMBERS WE COST, USING THE NUMBERS WE HAVE THERE. I JUST WANT TO SHOW THE DIFFERENCES. YOU'RE LOOKING AT A DIFFERENCE WHERE IF WE WERE FULLY INSURED, SELF-INSURED, YOU CAN SEE A DIFFERENCE OF 20 TO $30 MILLION IN DIFFERENT COSTS OF FULL OR SELF. >>Stacy Hahn: -- [INAUDIBLE] [MICROPHONE NOT ON] -- OR AGENDA ITEM. >>Van Ayres: YOU ARE ABSOLUTELY RIGHT. >>Stacy Hahn: AGENDA ITEM IN JUNE THAT SAYS CONTINUE DOWN A FULLY INSURED TRACK FULLY INSURED TRACK AND RENEW AETNA -- AETNA -- OR AGENDA ITEM THAT SAYS WE ARE MOVING TOWARD, I DON'T KNOW HOW IT WOULD BE WORDED, BUT INTO A WORDED, BUT INTO A SELF-INSURED PROGRAM. >> THE AGENDA ITEM HE WILL BRING WILL BE ONE OF THE TWO, NOT EITHER-OR. >> IF WE SAY NO COLLECTIVELY HE WOULD HAVE TO CHOOSE AN ALTERNATIVE ROUTE. >>Van Ayres >>Van Ayres: CORRECT. >>Stacy Hahn: SO JUNE. >>Van Ayres: LONG ANSWER TO SHORT ANSWER, JUNE. >>Stacy Hahn: WHICH WILL BE HERE BEFORE WE KNOW BEFORE WE KNOW IT, BEFORE WE KNOW IT, RIGHT? AS I'M HEARING EVERYBODY'S COMMENTS AND I APPRECIATE EVERYBODY'S QUESTIONS BECAUSE THEY WERE REALLY ALL GREAT COMMENTS AND QUESTIONS FROM BOARD MEMBERS, IT KIND OF SOLIDIFIED MORE FOR ME THAT WE, AS MEMBER COMBS SAID, WE PRIORITIZE OUR EMPLOYEES AND WE NEED TO MAKE SURE WE'RE PUTTING THINGS IN PLACE THAT WE CAN SAVE THEM MONEY. IF WE CONTINUE DOWN THIS FULLY INSURED ROAD, WE ARE BEHOLDEN TO THE INSURANCE COMPANY TO SET OUR RATES AND MAKE ALL THOSE DECISIONS FOR US. IF WE START TO MOVE TOWARD A SELF-INSURED PROGRAM, THEN WE CAN HELP TRY AND USE STRATEGIES TO DRIVE THE COST DOWN FOR OUR EMPLOYEES BECAUSE WE KNOW, WE KNOW IF WE STAY ON THIS KNOW IF WE STAY ON THIS FULLY INSURED ROAD, WE ARE INSURED ROAD, WE ARE GOING TO HAVE INCREASES 10% OR HIGHER EVERY SINGLE YEAR FOR OUR EMPLOYEES. THERE IS NO WAY OUT OF THAT. I THINK ANOTHER GOOD POINT MEMBER RENDON MADE, WHEN WE LOOK AT THIS CHART AND WE SEE THE PROJECTION FOR PROJECTION FOR SELF-FUNDED UNDER COST AND CLAIMS, WE HAVE TO REMEMBER THAT THAT'S BASED ON WHAT WE'RE CURRENTLY DOING, AND THAT INDEED UNDER SELF-INSURANCE, WE SELF-INSURANCE, WE ARE GOING TO NEGOTIATE NEGOTIATE LOWER RATES OR CONTRACTORS HOPEFULLY SO THAT CLAIMS ARE LESS AND WE'RE NOT IN THE POSITION THAT WE ARE RIGHT NOW. WE'LL HAVE MORE CONTROL OVER THAT, WHICH I THINK WE NEED. AND I THINK THE REBATES THAT WE GET TO KEEP JUST ON, MY GOODNESS, JUST ON CLAIMS COSTS ALONE IN ADDITION TO THE STATE TAX, AN ENORMOUS AMOUNT OF MONEY THAT THEN THAT THEN WE CAN USE TO MITIGATE THE RISK, FINANCIAL RISK. THOSE ARE ALL MY COMMENTS. THANK YOU. >>Jessica Vaughn: THANK YOU. I'M ALSO IN THE QUEUE. AFTER ME, MEMBER GRAY. ANYBODY ELSE WHO WANTS TO GET BACK IN THE QUEUE? AND MEMBER AND MEMBER RENDON. I HAVE YOU HERE, ACTUALLY. I AGREE. I APPRECIATE ALL THE CONVERSATION AROUND THIS. I GUESS WHAT MY I GUESS WHAT MY CONCERN IS, THERE'S TOO MANY UNANSWERED QUESTIONS ABOUT IF WE GO SELF-INSURED, WHAT DIRECTION WE'LL GO WITH THAT, WHAT WE'LL CHOOSE, WHAT THAT LOOKS LIKE FOR EMPLOYEES. AGAIN, I'M NOT REALLY CLEAR WHO MAKES THOSE DECISIONS, SO THAT'S MY MY HESITATION AND CONCERN ABOUT IT. WHILE I APPRECIATE THE SUPERINTENDENT SAYING WE WORKED VERY HARD TO GET THIS FUND BALANCE AND WE ALL KNOW THAT WE'VE HAD TO MAKE HARD DECISIONS TO GET HERE, A GOOD PORTION OF THAT FUND BALANCE COMES FROM OUR ESSER INFUSION AND ESSER INFUSION AND I'M NOT CONFIDENT ENOUGH RIGHT NOW WITH THE FINANCIALS WE HAVE TO FEEL COMFORTABLE THAT COMFORTABLE THAT WE'RE ALL GOING TO HAVE ACCESS TO BUILD THAT FUND BALANCE. WE KNOW HOW QUICKLY DEPENDING ON WHAT OUR FUNDING SOURCES AND REVENUES LOOK REVENUES LOOK LIKE, WHETHER OR NOT THE LEGISLATURE PASSES DIFFERENT THINGS THAT OUR FUND BALANCE COULD BE QUICKLY DEPLETED IF WE END UP IN AN OPERATIONAL DEFICIT JUST TO PAY OUR EMPLOYEES. HAVING TO MAINTAIN THAT CONSISTENT FUND BALANCE WITH SO MANY VARIABLES MAKES ME VERY CONCERNED. AGAIN, CONSIDERING THAT A GOOD PORTION OF IT, EVEN THOUGH I KNOW WE'VE MADE HARD DECISIONS, COMES DIRECTLY FROM THE ESSER INFUSION. THAT ALONG WITH, HERE SAYING ONE WAY OR ANOTHER WE'LL PAY FOR IT, I APPRECIATE THAT, MY QUESTION IS, WE'RE GOING TO PAY FOR IT EITHER WAY BUT WHAT IS IT GOING TO LOOK LIKE FOR ACCESS FOR OUR EMPLOYEES? THAT'S MY CONCERN. THAT'S WHERE I'M GETTING A LOT OF QUESTIONS THAT I DON'T REALLY UNDERSTAND WHERE THE ANSWERS ARE. WELL, THAT DEPENDS ON HOW WE WANT TO ENGINEER IT. YOU HAVE ALL THESE YOU HAVE ALL THESE OPTIONS, WE COULD BANK THOSE DECISIONS BUT I DON'T HAVE CLARITY ON WHAT THOSE LOOK LIKE. WHETHER WE PAY FOR IT OR NOT, AGAIN AGAIN MY CONCERN IS ACCESS FOR FOR OUR EMPLOYEES AND I DON'T HAVE THOSE ANSWERS. WHILE I APPRECIATE THE CONVERSATION, THAT'S WHERE I'M LEFT WITH A LOT OF QUESTIONS. I KNOW YOU HAVE COMMENTS TO THAT. >> I WANT TO CHIME IN. IF YOU SAY TODAY WE WANT TO SEE SELF INSURANCE AND WE FEEL LIKE TO KEEP THINGS SMOOTH FOR OUR EMPLOYEES WE WANT TO STAY WITH AETNA, THEN WE'RE NOT REALLY GOING TO BE MAKING ANY CHANGES. I THINK YOU KIND OF SHOULD FEEL GOOD ABOUT WHAT WE HAVE TODAY IS WHAT WE'LL HAVE IN '26. >>Jessica Vaughn: I DON'T NECESSARILY FEEL GOOD ABOUT THAT BECAUSE I HAVE A LOT OF CONCERNS ABOUT AETNA SINCE WE SWITCHED FROM FROM HUMANA. THAT DOESN'T NECESSARILY MAKE ME FEEL GOOD. THE LAST THING IS, IS THERE AN OPTION IF WE GO OPTION IF WE GO SELF-FUNDED AND WE HAVE THESE CHOICES TO MAKE OUR FAMILY PLANS LESS? AS CHAIR PEREZ POINTED OUT, WE HAVE VERY FEW EMPLOYEES WHO CHOOSE THE FAMILY CHOOSE THE FAMILY PLAN BECAUSE IT JUMPS FROM SUCH A HUGE AMOUNT IF YOU JUST COVER YOURSELF, IT'S ALMOST FREE TO COVERING A FAMILY. WITH SELF FUNDING, ONE OF THE THINGS I HEAR THAT'S GREAT IS YOU HAVE MORE FLEXIBILITY IN BUILDING THESE PLANS. WILL THAT BE A FOCUS OF THE DISTRICT IS MAKING SURE THAT FAMILY PLANS ARE MORE AFFORDABLE? >> HOW WE CHOOSE TO DO THAT, WE CAN DO THAT NOW. AETNA DOESN'T CARE THAT WE HAVE A FREE PLAN OR WE CHARGE A ZILLION DOLLARS, THEY HAVE THEIR COST AND WE MADE OUR DECISION IN THE DISTRICT TO PROVIDE A FREE INSURANCE PLAN, A FREE GREAT PLAN AND THAT MEANS THE DISTRICT IS IS SPENDING $110 MILLION JUST ON THAT FREE PLAN. IN THE FUTURE, IF WE WERE TO EVER LOOK AT JUST CHARGING A LITTLE BIT -- >>Jessica Vaughn: THAT DOESN'T CHANGE. IT'S BASICALLY HOW WE WANT TO STRUCTURE IT. >> YES, BECAUSE IMAGINE TAKING THAT 110 MILLION AND SPREADING IT OUT AMONG OTHER PEOPLE. OR MAYBE WHAT WE DO INSTEAD OF THE FREE PLAN, BE THE GREAT PLAN EVERYBODY IS ON, MAYBE THE HIGH DEDUCTIBLE PLAN AND OTHER PLANS WE COULD CHOOSE THAT WOULD STILL BE FREE THAT WOULD THEN ALLOW US TO SPREAD THE MONEY OUT. IT'S OUR INTERNAL DECISION HOW WE'VE CHOSEN TO FUND IT. >>Jessica Vaughn: OKAY. I'LL ASK MORE QUESTIONS LATER. I KNOW THAT MEMBER GRAY HAS MORE QUESTIONS AND THEN MEMBER RENDON. MEMBER GRAY. >>Lynn Gray: YEAH, I THINK IT'S BEEN A BEEN A VERY, VERY SUCCESSFUL MORNING. A LOT OF LEARNING A LOT OF LEARNING CURVES. I THINK ALSO I THINK ALSO WHEN MEMBER HAHN MENTIONS A TIMELINE, WE ARE VERY COMFORTABLE WITH A FIVE-YEAR PLAN. WHY DON'T WE HAVE A TIMELINE THAT WOULD SHOW NOT ONLY THE TIMELINE, BUT FROM 2026, TIMELINE, BUT FROM 2026, 2027, 2028 AND 2028 AND COMPARE THOSE DISTRICTS -- BROWARD, ORANGE COUNTY, DUVAL -- OF SIMILAR SIZE IN THE PREMIUMS WITH THE ADMINISTRATIVE COSTS, WITH THE COSTS, WITH THE ACCESSIBILITY TO EMPLOYEES, THOSE ARE THE CATEGORIES THAT YOU CATEGORIES THAT YOU HAVE ALREADY MADE COMPARISON BUT -- COMPARISONS BUT SHOULD BE DONE FOR FULLY INSURED AND SELF-INSURED. IN OTHER WORDS, IN OTHER WORDS, WE NEED TO SEE A COMPARISON IF THERE IS A TRUE SAVINGS. IF YOU'RE SAYING IF YOU'RE SAYING TO ME AS A PREVIOUS BUSINESS OWNER, THAT, OH, NEXT YEAR, YOU'RE GOING TO BE PAYING 30% MORE BE PAYING 30% MORE RENT, I WOULD BE OUT OF BUSINESS. IF THAT IS THE IF THAT IS THE STATEMENT, THEN THAT -- WELL, IT'S TRUE. RENT COSTS A LOT OF MONEY AND OVERHEAD. BUT IF IT'S A GRADUAL AMOUNT, SAY 10% ONE YEAR, 20%, SEE, ALL THAT TO ME WHEN THE STATEMENT IS THAT WE WILL SAVE MONEY, WELL, IT NEEDS TO BE SHOWN IN A WAY WHERE THERE IS NOT ONLY A TIMELINE BUT ALSO IN THOSE CATEGORIES. IN FACT, ARE WE SAVING MONEY? IT HAS TO BE PROJECTION, I UNDERSTAND. BUT YOU'RE PROJECTING, AS WE SHOULD, THAT AETNA WILL RAISE 10 TO 20 TO 20 TO 30. SO I NEED A COMFORT LEVEL AS -- I NEED TO BE CONVINCED THAT WE WILL SAVE MONEY. BUT I ALSO AM BUT I ALSO AM REMINDED WITH WHAT MEMBER VAUGHN SAID, THE ACCESSIBILITY FOR EMPLOYEES IS SO PARAMOUNT BECAUSE IF WE'RE TRYING TO ATTRACT AND RECRUIT AND KEEP OUR EMPLOYEES, THEY HAVE TO HAVE PLACES LIKE A HEALTH CENTER, LIKE PASCO COUNTY. THEY HAVE THEY HAVE TO ABSOLUTELY BE ABLE TO GET THEIR -- IF IT IS A COVID SHOT, FLU SHOT, IF THEY HAVE AN ANKLE THAT MIGHT BE ANKLE THAT MIGHT BE BROKEN, THEY HAVE TO HAVE ACCESS. SO ARE SO ARE WE REALLY GIVING EMPLOYEES A EMPLOYEES A BETTER PRODUCT? ALSO -- I GO BACK TO MEMBER HAHN, YES, A TIMELINE I THINK IS VERY, VERY IMPORTANT. HOW ARE WE GOING TO GO THROUGH THIS? I DON'T AGREE 2026. I I AGREE WITH MEMBER, ACTUALLY, MEMBER VAUGHN AND NADIA COMBS ALLUDED TO ALLUDED TO A MORE GRADUAL, SUCH AS WHAT YOU SUGGESTED TO 2027. THERE'S TOO MUCH OF A LEARNING I THINK MEMBER WASHINGTON, YOU HAD A VERY GOOD POINT. WHAT ARE THE REALITIES THAT THIS DISTRICT ACTUALLY HAS? YES, WE HAVE AN OLDER POPULATION? WHEN I TAUGHT AT WHEN I TAUGHT AT JESUIT, WE HAD AN OLDER POPULATION. WE HAD TO CHANGE OUR INSURANCE BECAUSE OF THE DEMOGRAPHICS WERE AGING UP. REALITY OF OUR DISTRICT COMPARED TO OTHER DISTRICTS, THEY ARE NOT ALL THE SAME. I THINK WE ALL AGREE WITH THAT. BUT YOU CAN'T MAKE A BLANKET ANALOGY BECAUSE WE DO HAVE AN OLDER POPULATION. AND THIS MAY CHANGE AS WELL. BUT RIGHT NOW, AS MEMBER COMBS MENTIONED, SO MANY TEACHERS SHORT, MAYBE WE WILL GET MORE YOUNG TEACHERS. ANYWAY, I THINK IF WE ANYWAY, I THINK IF WE DON'T UNDERSTAND THE REALITIES, THE MILLAGE MAY OR MAY NOT HAPPEN. WE DON'T HAVE A CFO, TO MEMBER WASHINGTON'S POINT. WE DO HAVE A WE DO HAVE A LESSENING OF A CIT TAX BY 20%. WE DO HAVE HURRICANES, WHICH GOES INTO THE FEDERAL -- INTO THE EMERGENCY FUND BALANCE. THOSE ARE VARIABLES THAT FOR US TO SAY, YES, IN NOVEMBER OR DECEMBER, EXCUSE DECEMBER, EXCUSE ME, 2026, LET'S SWITCH, I THINK WE NEED MORE TIME. NOT TO NOT TO MENTION NOT TO MENTION THE MOST IMPORTANTLY OUR EMPLOYEES. AGAIN, TO MEMBER COMBS' POINT, WE HAVE TO HEAR FROM THEM. WE HAVE TO MAKE SURE THAT THEY DON'T HAVE A SYNERGY NIGHTMARE IN FRONT IN FRONT OF THEM. BECAUSE RIGHT NOW ADMINISTRATIVELY -- AND THANK YOU FOR BEING THE ONE THAT TAKES CARE OF IT -- BUT IN THE VERY FINAL ANALYSIS, INDIVIDUALS WILL HAVE HAVE TO DO THE INTEGRAL PARTS OF CLAIMS AND THIS, THAT AND THE OTHER. THERE IS A LEARNING CURVE. I WOULD HATE TO LAYER ON ANOTHER ONE AT THIS TIME. I'M MORE FOR THE GRADUAL APPROACH AND WAITING APPROACH AND WAITING BEYOND 2026 TILL WE GET ALL OF THIS TAKEN CARE OF. I DON'T WANT TO MAKE A DEFINITIVE YES DECISION RIGHT NOW. >>Van Ayres: IF I COULD JUST RESPOND. DR. SHOTSBERG, DR. PATTON OR LORI, RESPOND TO THIS. IF AN AGENDA ITEM GAME IN JUNE OF '26, SELF INSURANCE -- IN '25 FOR '26 WHICH I THINK WAS OPTION ONE ON THE PLAN YOU PROVIDED, PART OF THE PLAN YOU PROVIDED, WOULD OUR EMPLOYEES NOTICE A DIFFERENCE? >> NO. >>Van Ayres: NO. TO ANSWER THAT, THERE IS NO DIFFERENCE AS FAR AS IF WE WENT TO SELF-INSURED, STAYED WITH AETNA, OUR EMPLOYEES, THE PLAN THEY ARE CURRENTLY ON WOULD NOT FEEL OR NOTICE A DIFFERENCE. I WANT TO BRING THAT POINT I WANT TO BRING THAT POINT OF CLARITY? >> WHEN DO THEY NOTICE? >> WE'RE IN CHARGE OF >> WE'RE IN CHARGE OF OUR BENEFITS PACKAGE CREATE A NEW PLAN. THAT HAPPENS WHETHER WE STAY SELF-INSURED OR -- AETNA COULD COME BACK IN 2026 AND SAY WE CHANGE THE WAY WE DO BUSINESS. RIGHT NOW IT IS WHETHER WE'RE IN CONTROL OF IT OR NOT. >> I KIND OF LOOK AT IT AS WE HEARD OUR ANALOGY TALK ABOUT WHETHER YOU RENT YOUR HOUSE OR OWN YOUR HOUSE. RIGHT NOW WE ARE RENTING THE HOUSE THAT WE'RE LIVING IN. THE OWNER IS PAYING FOR EVERYTHING, WHICH IS GREAT. WHEN WE HAD WHEN WE HAD BAD YEARS WHEN WE HAD BAD YEARS AND HURRICANES. HUMANA AS LONG AS WE HAVE ANDETTE AETNA WE'VE LIVED IN A RENT CONTROLLED BECAUSE WE'VE HAD HAD GREAT RATES. LET'S SAY THEY SOLD AND NEW OWNERS SAY YOUR RATES ARE GOING UP, IT'S TIME TO START OWNING SO THEN WE CAN HAVE MORE CONTROL. LIKE MAYBE WE DON'T WANT TO HAVE THE PARTICULAR PROCESSES AND PROCEDURES THAT ARE IN PLACE. >>Lynn Gray: PARALLEL TO THE POINT THAT YOU'RE MAKING AND MEMBER RENDON, PARALLEL IS THE IDEA THAT WE MAY NOT GET THE REFERENDUM. WE MAY NOT -- WE ARE GOING TO HAVE FISCAL REALITIES THAT WOULD REMIND ME REMIND ME OF 2016, 2017, 2018 WHERE WE WENT DOWN 3% FUND BALANCE QUICKLY NOT BECAUSE OF THE INSURANCE BUT BECAUSE OF THE AMOUNT OF EMPLOYEES. I DON'T WANT TO SEE THAT HAPPEN. THE GRADUAL WAY THE GRADUAL WAY OF FISCAL RESPONSIBILITY I THINK NEEDS TO BE -- WE NEED TO SLOW THE PROCESS DOWN. IF WHAT YOU'RE SAYING, THE EMPLOYEES WON'T EMPLOYEES WON'T EVEN KNOW THE DIFFERENCE, THAT IS THE OPTIMAL. >> WHETHER YOU OWN A HOUSE OR RENT A HOUSE, YOUR KIDS WHO LIVE THERE, DON'T KNOW. THERE IS A KITCHEN, BATHROOM AND ALL THE THINGS YOU NEED. IT FEELS THE SAME. >>Lynn Gray: IF IT FEELS THE SAME, AS LONG AS -- >>Henry "Shake" Washington: KEEP OUR EMPLOYEES IN PERSPECTIVE. THAT'S MY GOAL. >>Jim Porter: ONE THING I WANT EVERYONE TO KEEP IN MIND, THERE WILL BE AN AGENDA ITEM IN JUNE. THIS IS END OF THIS IS END OF OCTOBER. I THINK YOU ALL, ADMINISTRATION AND BOARD NEED TO THINK ABOUT WHEN IS THE NEXT TIME THE BOARD SHOULD GET TOGETHER TO GET QUESTIONS ANSWERED SO WE DON'T GET TO JUNE AND HAVE A CRISIS ON OUR HANDS WHERE YOU ARE FACED MAKING A DECISION UNDER PRESSURE. YOU NEED TO THINK ABOUT WHEN THIS BOARD NEEDS TO THIS BOARD NEEDS TO RECONVENE, WHETHER WORKSHOP OR INFORMATION ITEM, SO THAT YOU ARE NOT IN JUNE WITH THE DECISION AND ALL THESE QUESTIONS THAT ARE STILL UNANSWERED. >>Jessica Vaughn: WE STILL HAVE THREE PEOPLE LEFT WHO WANT TO BE IN QUEUE AND WE HAVE 15 IN QUEUE AND WE HAVE 15 MINUTES LEFT. MEMBER GRAY, ARE YOU FINISHED? OKAY. THANK YOU. THE THREE PEOPLE WHO ARE LEFT, IF YOU COULD PLEASE KEEP YOUR COMMENTS UNDER FIVE MINUTES SO EVERYONE ELSE HAS A CHANCE TO ASK QUESTIONS. >>Patti Rendon: THANK YOU. I WANT TO MAKE SURE I CLARIFY THIS. WE WILL CURRENTLY BE WE WILL CURRENTLY BE PUTTING WE WILL CURRENTLY BE PUTTING OUT $54 MILLION FOR THOSE THREE MONTHS, THE 90 DAYS THAT WE'RE REQUIRED TO HAVE IN RESERVE BECAUSE WE'RE ALREADY BECAUSE WE'RE ALREADY PAYING THAT FOR THE PREMIUMS OUT FRONT, AM I CORRECT IN THAT? SO RIGHT NOW IF WE STAY SELF-INSURED, THE MONEY WE HAVE TO PUT IN THE 90 DAY RESERVE IS WHAT WE WOULD HAVE BEEN WHAT WE WOULD HAVE BEEN PAYING ANYWAYS. >> CORRECT. >>Patti Rendon: FOR AETNA NOW. IT IS A MATTER WE WILL HOLD THAT IN SAVINGS AND THEN IN 90 DAYS WE KEEP REPLENISHING THAT SAVINGS ACCOUNT AS WE'RE PAYING PREMIUMS. WE'RE NOT PAYING ADDITIONAL MONEY. THERE'S NO ADDITIONAL MONEY GOING OUT. THE MONEY STAYS IN SAVINGS UNTIL WE START PAYING PREMIUMS. WE JUST CAN'T REDUCE THAT SAVINGS ACCOUNT SAVINGS ACCOUNT LOWER THAN THAT INITIAL -- WHATEVER -- >> LIKE A DOWN PAYMENT FOR THE HOUSE. >>Patti Rendon: 90 DAYS OF CLAIMS. 90 DAYS OF CLAIMS WE WOULD HAVE ALREADY BEEN PAYING IN PREMIUMS. >> YEP. >>Patti Rendon: IF WE DO NOT GO SELF INSURED, THAT FUND BALANCE IS GOING TO REDUCE, AM I CORRECT, BECAUSE WE ARE AUTOMATICALLY GOING TO BE PAYING FOR 13,000 EMPLOYEES, 10 TO 15 PERCENT MORE ON THEIR INSURANCE, WHICH IS WHICH IS TAKING MONEY DIRECTLY OUT OF THEIR POCKETS THAT WE CANNOT USE FOR RAISES BECAUSE WHETHER REFERENDUM PASSES OR NOT, WE NOT, WE ARE STILL RESPONSIBLE FOR PAYING THE INCREASE IN TEACHER SALARIES, NOT BONUSES. I WANT TO MAKE SURE WE'RE VERY CLEAR ON THIS THAT IF WE DON'T GO SELF-INSURANCE, WE'RE GOING TO BE TAKING MONEY OUT OF TEACHERS' POCKETS BECAUSE WE'RE GOING TO HAVE TO PAY THAT ADDITIONAL CLAIM, THOSE ADDITIONAL PREMIUMS ONE WAY OR THE OTHER. >> THE RENT IS GOING UP. >>Patti Rendon: THE >>Patti Rendon: THE RENT IS GOING UP NO MATTER WHAT. RIGHT NOW WE'RE LOOKING AT PAYING ADDITIONAL -- ALREADY PAYING 110 MILLION. GO UP GO UP ANOTHER 10 GO UP ANOTHER 10 TO $20 MILLION IN WHAT WE'RE PAYING AETNA THAT WE COULD BE WE COULD BE MANAGING THE MONEY OURSELVES, AND I DON'T MEAN PERSONALLY VAN AYRES OR OUR ACCOUNTING DEPARTMENT. WE ARE NOT GOING TO HAVE TO PUT IN OUR OWN CLAIMS, DON'T GO TO THE DOCTOR AND SEND IN THE DOCTOR AND SEND IN A TICKET. IT LOOKS DIFFERENT. WE HIRE SOMEONE TO DO IT OURSELVES AND NOT AETNA HANDLING ALL OF IT. THERE IS THE DIFFERENCE, AM I CORRECT? >> IT'S BANKING. WE WOULD BE PAYING THE BILLS VERSUS AETNA. >>Patti Rendon: CORRECT. I WANT TO MAKE SURE WE MAKE THIS VERY CLEAR BECAUSE THERE'S BEEN OUT OF THE FUND BALANCE AND PAY MORE MONEY, WE ARE ALREADY PAYING THAT MONEY IN OUR PREMIUMS. IT'S JUST ARE WE PAYING ONCE A MONTH OR KEEPING A SAVINGS ACCOUNT OF ACCOUNT OF THE 90 DAYS AND NOT PAYING IT TO AETNA FIRST. AS THE CLAIMS COME IN, WE PAY THAT. ALWAYS 30 TO 90 DAYS BEHIND A CLAIM. I GO TO A DOCTOR IN JANUARY, THAT CLAIM DOESN'T GET TO THE INSURANCE COMPANY -- WE SEE THAT. WE GET OUR REMITTANCE VOUCHERS FROM OUR INSURANCE TO SHOW WHAT WE PAID AND WHAT THEY DIDN'T PAY AND WHAT WE OWE. WE WE SEE THAT IS 60 TO 90 DAYS. AND THAT'S HOW THE MONEY WILL COME OUT. AS WE'RE PUTTING MONEY IN FOR THE PREMIUMS THAT OUR STAFF ARE PAYING OR WE'RE PAYING, WE'RE BECAUSE PAYING OVER 13,000 EMPLOYEES, WE'RE EMPLOYEES, WE'RE PAYING 100% OF THEIR PREMIUMS. >> THAT'S CORRECT. >>Patti Rendon: WE'RE >>Patti Rendon: WE'RE PAYING 100 PERCENT PREMIUMS, WHERE IF WE GO SELF-INSURANCE, WE HAVE THE FLEXIBILITY OF CREATING THAT COST. BECAUSE THAT COST NOW IS AETNA'S PROFITS. AETNA'S ADMINISTRATIVE FEES. AETNA'S THINGS THAT WE CAN REDUCE THAT. AM I CORRECT IN THAT? >> YES, MA'AM. >>Patti Rendon: I JUST WANT TO MAKE SURE BECAUSE THERE'S BEEN A LOT OF TALK ABOUT DIFFERENCE, MORE MONEY, MORE THIS, BUT WE'RE ALREADY PAYING IT. NOW WE'LL PAY MORE IF WE DON'T CHANGE THE WAY WE DO BUSINESS. >>Jessica Vaughn: ARE YOU DONE, MEMBER RENDON? THANK YOU, MEMBER RENDON. MEMBER COMBS. >>Nadia Combs: I WANT TO REITERATE BECAUSE I THINK SOME OF THIS IS A LITTLE BIT CONVOLUTED. I WANT TO SAY NO QUESTION, ONE OF OUR MAIN JOBS IS TO MAKE SURE WE ARE -- MAKE FISCAL, CORRECT DECISIONS AS SCHOOL BOARD MEMBERS. FOR ME THERE'S NO QUESTION WE HAVE TO MOVE TOWARDS SELF-INSURANCE. JUST LOOKING ALONE AT THE REBATES AND NOT PAYING THE TAX PREMIUM AND ALSO THE COST, IF I WAS AETNA RIGHT HERE AND I WAS WATCHING AND I THINK THAT YOU'RE GOING TO BE FULLY INSURED, I'LL GO UP 20, GO UP 20, 30, $40 MILLION BECAUSE I CAN DO WHATEVER I WANT BECAUSE THIS BOARD IS NOT WILLING TO TAKE -- I DON'T THINK IT IS A RISK BECAUSE OUR EMPLOYEES ARE NOT GOING TO FEEL THAT WAY. I DO WANT TO BE CLEAR I THINK -- WHEN I SAY GRADUAL APPROACH, WE NEED TO DO SELF INSURANCE RIGHT AWAY BUT GRADUALLY LOOK AT A THIRD PARTY AND SEE HOW SAVE MORE MONEY. COMPARE SOMETHING LIKE PASCO COUNTY, THAT DISTRICT IS VERY SMALL. I DON'T THINK THERE IS NO COMPARISON. TO GREAT ODESSA TO HEAR TODAY WAS OVER AN HOUR TO DRIVE, MUCH LESS IF GOING TO PLANT CITY, IT WOULD TAKE ME TWO WOULD TAKE ME TWO HOURS. THERE'S NO COMPARISON FOR THAT. THAT'S WHY I THINK INFRASTRUCTURE IS GOING TO TAKE A LOT LONGER. ONE THING I DON'T WANT TO DO, I WANT TO GO IMMEDIATELY TO SELF-INSURANCE BUT DON'T WANT TO THEN STAY STEADY AND SAY THIS IS THE WAY IT'S GOING TO BE. I IMMEDIATELY WANT TO GO IN TO SEE A LONG-TERM PLAN, TO START WORKING ON THE INFRASTRUCTURE, TO MAKING SURE THAT WE START SLOWLY ROLLING THAT OUT, TO START LOOKING AT A LOT OF DIFFERENT COMPANIES, DIFFERENT ORGANIZATION, DIFFERENT CONSULTANTS, LOOKING AT ALL OF THAT TOGETHER. ONE THING, I DON'T WANT TO SAY, OKAY, DO SELF-INSURANCE WITH AETNA AND WE'RE COMFORTABLE WITH THAT AND WE'RE NOT MOVING FORWARD. I DON'T WANT OUR EMPLOYEES TO FEEL IT BUT THEN PUT FEEL IT BUT THEN PUT ON 180 PEDAL TO THE METAL AND CONTINUE TO WORK FURTHER. I THINK THAT'S REALLY IMPORTANT. IT IS OUR BIGGEST DECISION. TO ME IT'S LIKE BLACK AND WHITE. HOW COULD WE NOT GO TOWARDS SELF-INSURANCE? WE HAVE TO GO TOWARDS IN THAT DIRECTION. I FULLY SUPPORT THAT. I HOPE WE HAVE AT LEAST FOUR MEMBERS. IF NOT, I THINK WE NEED TO PUT THIS ASIDE, YOU'LL BRING THE ITEM IN JUNE, THAT GIVES ALL THE SCHOOL BOARD MEMBERS TIME TO INTERACT WITH YOU AS WELL AS THE SUPERINTENDENT TO HAVE SMALL MEETINGS SO THAT WAY IN JUNE THAT DECISION CAN BE MADE VERY CLEARLY. I DEFINITELY THINK NO MATTER WHAT, WE NEED TO BE HEADING IN THAT DIRECTION AND PEOPLE NEED MORE TIME. I'M GOING TO NEED MORE TIME AND ALSO WANT TO BE MORE INVOLVED IN WHAT THAT LOOKS LIKE NOT JUST THE FOLLOWING YEAR BUT AFTER THAT AS WELL. THANK THANK YOU. >>Jessica Vaughn: THANK YOU, MEMBER COMBS. DR. HAHN AND THEN WE'LL CARVE OUT SOME SPACE FOR MEMBER WASHINGTON AFTER HAVE HAHN. >>Stacy Hahn: ONE THING I WANT TO GO BACK TO, COMMENTS MADE AROUND THE CIT AND AROUND THE CIT AND REFERENDUM, TRYING TO TIE THIS TO SAY IF THAT DOESN'T PASS, THEN THIS IS PUT IN JEOPARDY. THIS IS NOT THE SAME POT OF MONEY. THE MONEY THAT WE ARE USING, WHETHER WE WHETHER WE SELF-INSURE OR FULLY INSURE IS NOT MONEY WE WOULD BE USING TO NEGOTIATE USING TO NEGOTIATE RAISES FOR TEACHERS. THAT NEEDS TO BE MADE CLEAR. WHETHER WE MOVE FORWARD WITH THIS OR NOT, IT HAS NOTHING TO DO WITH THE REFERENDUM, CIT. IT'S SOLELY THIS POT OF MONEY THAT WE HAVE TO USE FOR HEALTH INSURANCE. I I THINK THAT NEEDS TO BE MADE REALLY CLEAR. I THINK IT MUDDIES THE WATERS AND MAKES IT SEEM THIS WILL NOT BE POSSIBLE TO DO IF SOMETHING DOESN'T HAPPEN WITH THE TWO REFERENDUMS OR REFERENDUMS OR AMENDMENTS. I THINK FROM THE USER SIDE, THERE'S BEEN A LOT OF CONCERN AROUND HOW EMPLOYEES WILL FEEL WITH THIS CHANGE. GLAD YOU BROUGHT UP LIKE YOU LIVE IN A HOUSE AND YOU RENT IT AND BUY IT AND LIVING IN THE SAME HOUSE, NOTHING HAS CHANGED. USER SIDE, EMPLOYEES WON'T EVEN KNOW THAT THE CHANGE WAS MADE. THEY'LL GO TO THE DOCTOR AND DO THEIR THEIR COPAY AND IT THEIR COPAY AND IT COULD BE BETTER. IT COULD CHANGE IF WE MOVE FROM AETNA AETNA TO ANOTHER HEALTH INSURANCE COMPANY, BUT WHETHER WE HAVE HUMANA OR AETNA, I STILL WENT TO MY DOCTOR AND PAID MY COPAY. IT DOESN'T MATTER. MAYBE MY COPAY WAS $5 MORE OR $5 LESS OR WHATEVER, BUT THE USER IS NOT GOING TO FEEL A BIG DIFFERENCE. WHERE THEY ARE GOING TO FEEL THE DIFFERENCE IS IN THE DIFFERENCE IS IN THE SAVINGS, HOPEFULLY, TO WHAT THEY ARE PAYING. THAT'S WHAT OUR MAIN GOAL, I CAN HEAR EVERYONE SAY, WE HAVE TO FIGURE OUT A WAY TO DRIVE DOWN COSTS FOR EMPLOYEES AROUND HEALTH CARE AND HAVE SOME CONTROL OVER THAT. I'M WITH MEMBER COMBS AND MEMBER RENDON AND SOME OF MY OTHER COLLEAGUES HERE, I WANT TO MOVE FORWARD. >>Jessica Vaughn: THANK YOU, DR. HAHN. MEMBER WASHINGTON. >>Henry "Shake" Washington: ONE MINUTE. FREEDOM OF FREEDOM OF CHOICE. AS LONG AS WE HAVE FREEDOM OF CHOICE, YOU HAVE ANOTHER PERSON ON BOARD. YOU HAVE SHAKE YOU HAVE SHAKE WASHINGTON. BUT IF DON'T HAVE THAT, I'M NOT ON BOARD. >>Jessica Vaughn: THANK YOU, MEMBER WASHINGTON. >>Van Ayres: I WANT TO THANK DR. SHOTSBERG. LORI YOU AND YOUR TEAM. I APPRECIATE BOARD THE DISCUSSION. I THINK I'VE GOT DIRECTION NOW. YOU'LL SEE LOTS OF ONE-ON-ONES ALSO ON TOP OF THIS AS WE MOVE FORWARD TO JUNE. ULTIMATELY A BOARD AGENDA ITEM IN JUNE THAT WILL COME BEFORE THE BOARD FOR A VOTE. I JUST APPRECIATE THE BOARD'S INPUT IN GETTING US TO THE DECISION. TOOK A COUPLE OF HOURS BUT IT IS AN IMPORTANT, IN-DEPTH DISCUSSION AND I FEEL LIKE WE GOT TO A SOLUTION TODAY. THANK YOU. >>Karen Perez: THANK YOU. WITH THAT SAID THIS MEETING IS ADJOURNED. [ SOUNDING GAVEL ]