STAYWELL Mendocino County School Districts Health Plan

Steering Committee (ONLY) Meeting

8:30 a.m. - 9:30 a.m. South East Room – Note Room Change

AGENDA

STAYWELL COMMITTEE MEETING Thursday, March 21, 2019

Mendocino County Office of Education River Room

9:30 a.m. -12:30 p.m. 9:30 Call to Order

Introductions Approval of Agenda Approval of Minutes (Staywell –January 25, 2019) Public Input

9:40 Reports Steering Committee Utilization Report Rick Lapuz 2018-19 Claims Update Becky Jeffries 10:15 Wellness Program Wellness Program Proposal – Blue Shield Joe Juarez *Blue Shield Tivity Health Program Joe Juarez Wellness Program Contest Submissions Traci 11:00 Renewal Update Jordan via phone

1. Blue Shield, CV Trust, SISC 2. Arrow Review of Staywell

11:30 Action/Discussion Items Non-compliance Bylaw Enrollment Scenarios Katie/Traci AirMedCare Rate Increase 12:00 Other Action/Discussion Items Bylaws Revisions Traci

a. 2st Reading – Eligibility, Page 9 #6 … Since all eligible employees must enroll in Staywell, employees whose spouse or domestic partner works in a participating Staywell District with both employees enrolled in Staywell, will (each) receive a 12.5% discount on their monthly premiums.

b. 2nd Reading – Eligibility, Page 9 #7 – NEW (if Action Item “65 YO Opt Out Option” passes) – Members that reach age 65 or older may opt out of Staywell to participate in Medicare. They may not opt out for any other reason.

STAYWELL Mendocino County School Districts Health Plan

c. 2nd Reading – Enrollment, Page 10 #4 – Add: An employee that is less than .875 FTE who has voluntarily participated in Staywell and who has voluntarily dropped

d. 1st Reading – Eligibility, Page 8: Add #8 (to page 9): - Staywell

benefits cannot be offered to anyone that does not meet the eligibility criteria as outlined in the Staywell Bylaws. Staywell benefits can only be offered to employees (and qualifying substitutes) that meet employment eligibility. (1st Reading 3/21/2019)

19/20 Meeting Calendar (Draft) Traci 12:30 Adjourn Upcoming Meetings:

May 3, 2019 o Steering Committee 8:30 – 9:30 (MCOE East Room) o Full Committee 9:30 – 12:30 (MCOE River Room) o

May 31, 2019 o Steering Committee 8:30 – 9:30 (MCOE East Room) o Full Committee 9:30 – 12:30 (MCOE River Room)

STAYWELL COMMITTEE MEETING Friday, January 25, 2019

MOCE – River Room 9:30 a.m. -12:30 p.m.

PRESENT Anderson Valley: Jason Page Nicole Mclain Arena Union Elementary: Bernadette Maul Kelly Piper Ft. Bragg: Linda Stephens Melissa Schlafer Wendy Boise Laytonville: Bette Loflin Nancy Golightly Leggett: Tony Loumena Manchester: Cynthia Gonzalez Elsie Piper MCOE: Craig Perry Debbie Rogers Vacant Point Arena: Andrea Mazza Eloisa Oropeza Phyllis Wade Potter Valley: Joleen Logan Justus Hawks Krista Looney Round Valley: Amanda Derby Barbara Figueroa Jonathan Dunn Willits: Daniel Green Nikki Agenbroad Tessa Ford Horicon: Darshan Hodges Patti Pomplin Tammie Nichols Charter Academy: Jim Switzer* Blue Shield Representatives: Diana Tse* Rick Lapuz* Arrow Benefits Representatives: Jordan Shields* Staywell CFO: Becky Jeffries* Staywell Recorder: Traci Doster* Others: Katie Pearson* Debbie Courtney* Janice Downes* *Non-voting Participants ABSENT Anderson Valley: Leigh Kreinhop Arena Union Elementary: Daniel Jimerson Leggett: Brianna Parkinson Jeffery Allen MCYP: Randi Sanchez Mellus* Arrow Benefits Group: Keith McNeil*

STAYWELL

Mendocino County School Districts Health Plan

Staywell Committee Meeting January 25, 2019

Page 2 of 5

CALL TO ORDER .

The meeting was called to order by Wendy Boise at 9:30 a.m.

INTRODUCTIONS .

Introductions were made

APPROVAL OF AGENDA .

MSC Tessa Ford/Eloisa Oropeza, to approve and adopt the agenda of January 25, 2019. Discussion, change of location for 3/21/19 Steering Committee Meeting to Southeast Room, possible date change for 3/21/19 meeting, add action item to allow couples working in different districts to also receive the 25% discount. Motion carried (29/0).

APPROVAL OF MINUTES – OCTOBER 25, 2018 .

October 25, 2018 – MSC Linda Stephens/Debbie Rogers, to approve and adopt the minutes from Staywell Meeting on May 11, 2018, with the correction of Wendy Boise opened meeting. Motion carried (29/0).

PUBLIC INPUT .

None. Jason Page reported that long time Committee member; Carolyn Livingston lost her house in a fire. There are fundraising efforts taking place at the school. Please see Jason for information. REPORTS

Key Indicator Report:

Documents: Utilization Deck Financial Measure – Jan 2018-Dec 2018 vs Jan 2017-Dec 2017: Slight increase in membership – Inpatient – 79.5% increase in inpatient facility paid claims - correlates to high cost claimants – slight decrease (9.5%) on paid outpatient facility, Increase of 29.5% paid professional, 2.2% increase paid pharmacy – summary overall 22.3% increase over this time period last year. Expense Measure Incurred claims: Current, Oct 2017-Sept 2018 vs Prior, Oct 2016-Sept 2017 – with 3-month runout. Average number of employees remained the same. Slight increase in number of dependents resulting in an overall increase of 2.1%. Average Age Years (includes dependents) of group is 36.2. Average age of all members is approximately 50 (+/-) yrs. Percentage of childbearing females is 19.4% = increase of 4.3%. Utilization and price overview – Inpatient Facility saw an increase of 5.4%. Slight increase in outpatient and professional. Paid per service, increase of 41.7%. Outpatient Facility saw a decrease of 5.5%. Professional services increased 7.2%, and pharmacy saw an increase of 9.3%. Chronic conditions are driving increases as opposed to professional services increase – seeing a mature demographic. Medical paid PMPM 19.4% increase, Pharmacy 5.1% increase over last year. - High cost claimants 8.8% of the 19.4% change was the result of a medical expense increase associated with high cost claimants. Utilization: 8.6% of the overall medical PMPM change was the result of change in utilization of services. Seeing more chronic conditions and more severe conditions. Total increase for inpatient facility and professional, 53.3% January 1, 2019, Blue Shield added case management for musculoskeletal disease and behavioral case management to Staywell’s plan – no extra cost to plan. Members over 65 are impacting claims. Claims over 50K (high cost claimants): 63 claims over 50K = $7.9 million. Twenty-five claims over 100K = 5.3 million. Fifty-five percent of claims are high cost claimants – January 2018-December 2018. Preventative visits – Females are getting more preventative visits over males. Overall preventative visits increased by about a half a percent to 20.7% – should be seeing at least 30%. Outpatient facility usage – overall 5.5% decrease. Using an ASC Ambulatory Surgery Center is less expensive than using an outpatient surgery facility – Summary, ASC can save about 112% - encourage members to use the ASC’s when possible. Radiology summary –– did see higher increases in nuclear medicine and “other “imaging”, but recognized a decrease of 5.1% overall.

Staywell Committee Meeting January 25, 2019

Page 3 of 5

ER Summary – Paid per Service increased 181%. Non-emergent ER visits are at 6.2% of visits – very good. May be a result of Teladoc. Educational Opportunities were reviewed (send out Teladoc info again). Rick discussed Blue Shield’s quality assurance team for claims. 2018-2019 Claims Update: Becky

Documents: Staywell 2018-19 Claims & Premiums Becky provided the 2017/18 year-end report. For the current year, 2018/19, stoploss claims are trending high again. As of the End of December 2018, there are three claims over $200K and two more are on the high cost list. July 2018 was one of Staywell’s highest claim months ever at $1.4 million. We are trending upwards again this year. Wellness Update: Traci

Documents: None Traci reported that based on the continuing increases in claims, Staywell Wellness programs have not worked for our group in the past. A Wellness sub-committee was formed in May 2018 however; the committee has not been able to meet. It was decided that Staywell will run a contest asking members to submit ideas for a Wellness program. If one of the ideas submitted is selected, the member that submitted the idea will win a free Fitbit Zip. Becky Jeffries added that she would personally contribute a $100 gift card from Amazon in hopes of enticing more participation. The contest is on the February 2019 Staywell Newsletter. Jordan mentioned that he has visited three school districts in the past year to discuss our health plan and benefits. He offered to continue providing his services to all of the districts that would like him to visit. ACTION / DISCUSSION ITEMS

Deep Dive Look at Plan: Jordan

Documents: Staywell Health Plan Review by Arrow Benefits Group

Jordan Shields announced that Arrow Benefits Group has merged with 16 other partners around the country to form a new company Patriot Growth Insurance Services. Patriot is the 60th largest insurance broker in the country. Jordan and his partner, Keith McNeil have also formed another new company called Self-Insurance Experts (specializing in deep diving into analytics). Jordan recapped the key points in Staywell’s utilization and high cost claimants. Arrow is shopping for a new stoploss company that would have a rate cap. Possible ways to control healthcare costs were discussed. Some of the ideas discussed were; referenced based pricing, steering members to lower cost lab, imaging, and surgery locations, medical bill review and dependent audits, and specialized care for diabetics. Arrow Benefits Group has been using Vital Incite (a data analytics program) to analyze the data of Staywell claims. The analysis revealed that Staywell members obtain preventative visits (physicals, mammograms etc.) below industry norms. Staywell has an unusually high number of members who do not use the plan at all. In 2017, 484 members did not obtain any medical care, of those, 278 still had not obtained any medical care by September 2018. The data shows there is a significant number of members who are diabetic and have serious gaps in care. Jordan provided the Startup cost expenses as well as the annual expense estimates for Acorn Health Solutions. There may be other agencies interested in sharing the clinic with Staywell. Jordan will reach out to SIGNAL to see if they are interested as well. More information to follow. CVTrust Update: Jordan Included in the Deep Dive Look (previous item) – Estimate of startup and annual costs provided. More information to follow.

Staywell Committee Meeting January 25, 2019

Page 4 of 5

Quest Update: Jordan Nothing to report. Action Item – Bylaw Change Request - Allow Members 65 & Over to Opt Out of Benefits:

MSC Tessa Ford/Eloisa Oropeza to approve allowing members 65 years or older to opt out of Staywell – Discussion: Committee members further discussed the pros and cons of allowing members age 65 and older to opt out of Staywell to participate solely in Medicare. Financial impact to the budget was discussed. If motion is carried by committee, and districts have members that would like to opt out of Staywell, the members will be instructed to contact Jordan Shields of Arrow Benefits. He will provide them with their Medicare and health plan options. Reminder, employers cannot in any way, encourage members or dependents to drop from plan. If they express an interest, refer them to Jordan. Dependents are not required to remain on the Staywell plan past age 65. They have the option to drop from the plan at any time. A Medicare handout was provided in the agenda packet. Members can remain on Staywell and sign up for Medicare (as their secondary benefit provider) however, Jordan does not advise that, as it is very difficult to coordinate the benefits. Currently there are 126 members age 65 or older on the Staywell plan. Of those, 52 are employees and 74 are spouses. Motion carried (29/0). Action Item – Bylaw Change Request - Allow Married/Domestic Partners County-Wide to Receive 25% Discount

MSC Eloisa Oropeza/Nancy Golightly to approve allowing married/domestic partners working in different districts to receive the 25% discount that couples working in the same district currently receive. The discount would be split equally at 12.5% per member. Discussion regarding financial impact. Slightly less revenue would be received if motion is carried. Discussion regarding leaving existing couples at 25% for one member vs changing all to 12.5%. It was decided that due to the new financial system (ESCAPE), it would be best to make it universal across the county to 12.5% per each member. Clarification: the 25% discount only applies to couples and does not extend to dependent children working within the Staywell districts. Motion carried (29/0). BYLAWS AMENDMENTS – 1ST READING

Bylaws 1st Reading All

Documents: Staywell Bylaws

a. 1st Reading – Eligibility, Page 9 #6 … Since all eligible employees must enroll in Staywell, employees whose spouse or domestic partner works in a participating Staywell District with both employees enrolled in Staywell, will (each) receive a 12.5% discount on their monthly premiums.

1. Discussion regarding the language and whether to leave the old language and add the new language. It was decided that it would be best to change the language to what is recommended in 1st Reading (above) – Changes to Eligibility Page 9, #6 will be effective July, 2019 if motion is carried at March 21, 2019 Committee meeting. Item to be brought for 2nd reading and approval on March 21, 2019.

b. 1st Reading – Eligibility, Page 9 #7 – NEW (if 1/25/19 Action Item “65 YO Opt Out Option”

passes) – Members that reach age 65 or older may opt out of Staywell to participate in Medicare. They may not opt out for any other reason.

1. Committee members were in agreement with proposed wording. Item will be brought to March 21, 2019 meeting for 2nd reading and approval.

c. 1st Reading – Enrollment, Page 10 #4 – Add: An employee that is less than .875 FTE who has

voluntarily participated in Staywell and who has voluntarily dropped

Staywell Committee Meeting January 25, 2019

Page 5 of 5

1. Committee members were in agreement with proposed wording. Item will be brought to March 21, 2019 meeting for 2nd reading and approval with the correction of .875 FTE to .85 FTE.

d. 2nd Reading - Committee Meetings Page 4, #4 – spell out CFO (Chief Financial Officer)

1. MSC Nikki Agenbroad/Nancy Golightly, to approve amendment d.1., to spell out Chief Financial Officer. Motion carried (29/0).

e. 2nd Reading - Staff Page 4, #3 (on page 5) – spell out CFO (Chief Financial Officer)

1. MSC Eloise Oropezo/Linda Stephens, to approve amendment e.1., to spell out Chief Financial Officer. Motion carried (29/0).

f. 2nd Reading - Finance Page 5 – Change stabilization fund to: stabilization fund equal to a minimum of 2-2 ½ months of premiums (or approximately 12-15% of paid claims)

1. MSC Patty Pomplin/Nancy Golightly, to approve amendment f.1., Finance Page 5, to read “Stabilization fund equal to a minimum of 2-2 ½ months of premiums (or approximately 12-15% of paid claims). Motion carried (29/0).

OTHER

Discussion regarding March 21, 2019 meeting date. Request to find alternative date. No other dates available. Meeting date to remain March 21, 2019. Traci reviewed the handouts that are included with the Agenda packet. Revise and reissue Newsletter to reflect changes to Staywell Wellness Contest ($100 Amazon Gift Card for winning submission). ADJOURNMENT

MSC Linda Stephens/Nancy Golightly to adjourn. Motion carried 29/0. Meeting adjourned at 12:15 p.m. UPCOMING MEETINGS

Next meeting dates: March 21, 2019 - 9:30 am – 12:30 pm - MCOE River Room May 3, 2019 - 9:30 am – 3:30 pm - MCOE River Room

IF NEEDED: May 31, 2019 - 9:30 am – 12:30 pm - MCOE River Room

* Taxes may apply. Individuals must be at least 18 years old to purchase a membership.

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Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2019 Tivity Health, Inc. All rights reserved.

Tivity health discounts are not a covered benefit of Blue Shield health plans, and none of the terms or conditions of Blue Shield health plans apply. Tivity Health discounts are available to all members with a Blue Shield medical, dental, vision, or life insurance plan. The network of Tivity health providers and facilities in this program are managed outside of Blue Shield of California. Blue Shield does not review the services provided by Tivity Health, nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the providers, their availability, fees, services, or products.

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blueshieldca.com

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1 These discount program services are not a covered benefit of Blue Shield health plans, and none of the terms or conditions of Blue Shield health plans apply. Discount program services are available to all members with a Blue Shield medical plan, dental plan, vision plan, or life insurance plan.

The networks of practitioners and facilities in the discount programs are managed by the external program administrators identified below, including any screening and credentialing of practitioners. Blue Shield does not review the services provided by discount program providers for medical necessity or efficacy. Nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products.

Some services offered through the discount program may already be included as part of the Blue Shield plan covered benefits. Members should access those covered services prior to using the discount program.

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• QualSight, LLC and NVISION Laser Eye Centers

2 Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).

3 The Discount Provider Network is available throughout California. Coverage in other states may be limited.

4 Requires a prescription from your doctor or licensed optical professional.

* The Alternative Care Discount Program is available to members with a Blue Shield medical plan. You are obligated to pay participating healthcare providers directly for the discounted services. The ChooseHealthy program has no liability for providing or guaranteeing services and assumes no liability for the quality of services rendered. Discounts on products and services available through the ChooseHealthy program are subject to change. Please consult the ChooseHealthy website for current availability. ChooseHealthy is a federal registered trademark of ASH and used with permission herein.

Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2018 Tivity Health, Inc. All rights reserved.

Tivity Health discounts are not a covered benefit of Blue Shield health plans, and none of the terms or conditions of Blue Shield health plans apply. Tivity Health discounts are available to all members with a Blue Shield medical plan, dental plan, vision plan, or life insurance plan. The network of Tivity Health providers and facilities in this program is managed outside of Blue Shield of California. Blue Shield does not review the services provided by Tivity Health, nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the providers, their availability, fees, services, or products.

The Diabetes Prevention Program is provided by Solera Health, an independent company.

Fitness your way is a trademark of Tivity Health, Inc.

Wellvolution is a registered trademark of Blue Shield of California.

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WELLNESS CONTEST ENTRIES

**Entries are in random order

** I was thinking maybe we can do some derby's through Walkadoo to encourage more walking. Maybe small prizes could be considered for the winners. Like something as small as a $10.00 gift card or something. This might get people more involved. I am not sure what the numbers were like when there were chances of winning something for participating in the Daily Challenge and Walkadoo, but it just seems logical that more people would be interested if there were rewards. I don't know, just an idea.

** I'm not sure if this was the kind of program you were looking for, but I've been learning more about cholesterol lately and I had an idea of a program for that. I've learned that heart disease is the #1 killer in the US, and how it comes mostly from saturated fats. Preventative measures I've been taking are trying to keep daily intake under 10 or 11 grams, or under about 70 per week. (Most Americans get way more than this without even knowing).

So my idea for the program is to track your intake, first by making a chart of the most common things you eat in your fridge and pantry, of how many grams you'd get with your normal serving size. For example, I did this with milk (my serving size was 2 cups in my to-go mug), condiments, different oils and fats, the cheese I most often buy, plus all the pre-made food or mixes like bisquick, frozen pizza or lasagna, brownies, etc.

From this I was able to make changes in what I purchase--I now only use non-fat milk, and I substitute vegetable oil for butter or coconut oil whenever I can, and limit things like pizza, brownies and lasagna.

So my idea was to make the chart for your own intake, and track 3 or 4 days out of the week to see if you can lower it.

The last intervention would be taking fiber pills, which some say are the best way to lower bad cholesterol.

I know it's not as easy as a fitbit, but perhaps taking pictures of the chart and submitting them to a database would work--or making it online.

** Incentivize the purchase of health equipment

** I would like to suggest that Staywell help school districts provide fitness instruction to their staff members. For instance, I would like to propose to staff & administration that it would be in the district's and it's employees benefit to hire a yoga/meditation instructor for after school classes for staff.

Before I submit my proposal I need to do research on the benefits of doing this. It would be nice if it were done for me.

** I think that instead of giving out gift cards for participation in Walkadoo, that it might be great to offer a refund type program, up to a certain dollar amount ($50? $100?) for members who are paying for fitness classes and/or gym memberships, or towards investment in equipment used for physical activity - perhaps a % of the total cost up to a limit. For example, if a member provides receipts to show participation in weekly Yoga classes, they could get 10% back up to $100. Or if someone is paying membership fees at the gym or Recreation Department or is paying a personal trainer. Or, if someone buys a bicycle, kayak or a treadmill (something along those lines) and can show receipt. I think it would need to allow for a variety of types of activities, and not be restricted to just gym memberships.

Perhaps this same sort of refund idea could also be applied to folks investing in weight loss programs. I've never done one of those, so I don't know how they work, but maybe?

I think this model would require the individual to make the initial investment, and since it's only a % of their total investment that would be refunded, it demonstrates personal commitment to improved health.

** Money toward the purchase of a wellness-tracking device (Fitbit, Apple, etc.

Staywell Health Plan Review—

A Time to Consider Changes

March 21, 2019

2

Executive Statement by Arrow Benefits Group

The Staywell renewal is being worked on but the stop-loss renewal has not yet been received.

First the good news: the claims experience is leveling off and getting better. The stop-loss policy loss ratio through February is only 16.85% At the same time a year ago, the loss ratio was 104.6%. (When the policy year ended, the loss ratio was 173%.)

Now the bad news: the claims experience has increased significantly the last three years compared to the roughly level claims the six years before. We believe this is a call to action.

The following two slides show the claims experience over the last ten years and over the last two years:

Here are net costs an a PEPM basis for the time period 2009-2019 with certain reasonable assumptions made for the earlier years for administrative costs, rebates, etc.:

3

Costs were relatively flat through 2015, but since then costs have been on the rise. The following slide looks at

more recent data.

Here are costs from January 2017 through February 2019, compared to the target PEPM cost for the 2018-2019 year. The trendline is leveling off and even going down.

4

Note: the preliminary costs for February are in and the average costs for July-February are about 2.95% under the

target.

5

All aspects of the plan are under consideration, including potential new claims payers, networks, stop-loss insurance, and Pharmacy Benefit Managers (PBM). A large number of niche vendors that focus on specialized component parts of a health plan are also under review. Here are samples:

—Medical Billing Error Detection [potential savings $250,000+/year]—Identify low cost providers and make members aware of them—Data analysis can show which members need to be contacted regarding gaps in their care.—Strategies for dramatically lowering Dialysis claims, if any—Options to create a greatly reduce unneccessary musculoskeletal surgeries (MSK) [50+% of these surgeries are not needed according to a recent large study]—Innovative and new treatments for allergies and stem-cell treatments for MSK—Concierge services tied to medical quality and cost data for physicians locally and around the country.—Variable copay and other PBM innovations, including patient advocacy [potential savings $100,000+/year]—Make Expert Second Opinions mandatory for many diagnoses and proposed treatment plans—Surgery and other bundles, including potentially domestic medical tourism—Onsite medical clinic proposal from Acorn Health

6

In addition, Staywell is also entertaining proposals for alternative self-funded programs (CVT and SISC) as well as a bid for consulting services from CECHCR.

As a general statement, Staywell will need to decide by about May 1 for potential changes to be ready by July 1, 2019.

A follow-up meeting with the Steering Commitee will take place early in April to review these

options in greater detail, when more detailed information will be available.

Mendocino County Staywell Committee

Bylaws NAME

The Board of Directors shall be known as the Mendocino County Staywell Committee and is referred to in this document either as Committee or as Board. (Amended 2/15/96)

PURPOSE

It shall be the purpose of this Committee to find ways to contain medical costs while preserving a high quality of medical coverage in the following ways: (Amended 10/4/02)

1. Utilize the combined resources and membership of agencies as a bargaining tool for negotiating with medical carriers and healthcare providers. (Amended 1-26-17)

2. Create a network within the county to educate membership relating to wellness-awareness and health consumer literacy.

3. Address issues and reach decisions regarding health insurance matters that affect entire membership. (Amended 9/23/06)

MEMBERSHIP

1. The participating agencies shall be: (Amended 2/4/11)

Anderson Valley Unified School District Arena Union Elementary School

Fort Bragg Unified School District Horicon Elementary School District Laytonville Unified School District

Leggett Valley Unified School District Manchester Union Elementary School District

Mendocino County Office of Education Point Arena Joint Union High School

Potter Valley Community Unified School District Round Valley Unified School District

Willits Unified School District Ancillary Agencies:

MCOE – MCYP MCOE – Charter Academy of the Redwoods MCOE – Accelerated Achievement Academy

RVUSD – Eel River Charter School

2. Each agency shall consist of all eligible members of the agency and commit to three (3) years of membership. (Amended 9/29/95)

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3. Each agency shall be represented on the board by the following: (Amended 2/15/96)

One Certificated Bargaining Unit Member One Classified Bargaining Unit Member

One Administrator

4. Each agency shall determine its own method of selecting the certificated and classified representatives. It is recommended that each representative serve a minimum two-year term. (Amended 2/10/94)

5. Alternate members may also be selected for each delegate. (Amended 2/10/94)

6. Each agency shall annually adopt a resolution and submit to the Administrative

Agency by March 1 to continue participation in the Staywell group and agree to uphold the bylaws and policies. (Amended 1/26/17)

7. Additional educational agencies may be added to the pool with a two-thirds vote of the total committee membership.

QUORUM

1. Each board member present shall have one vote.

2. More than 50% of the membership shall constitute a quorum for the transaction of business. (Amended 5/28/92)

3. Changes in fiscal responsibility, coverage, or plan shall be made by a two-thirds vote of the eligible membership present. (Amended 2/10/94)

4. Each voting member should have been a participant on the Staywell Board for two meetings of the current contract year when the next year’s health contract is approved.

OFFICERS

1. The term of office shall be one year.

2. The chairperson shall:

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a. Conduct the meetings. b. Represent the Board in negotiations with carriers

3. The Steering Committee shall be elected at the spring meeting. The Chair and Vice

Chair shall be selected by the Steering Committee. (Amended 2/10/94) STEERING COMMITTEE

The Steering Committee shall consist of six (6) members. Members shall include the current Chairperson, Vice Chairperson, the past Chairperson (when still available – if not available, an additional member is selected), the Chief Financial Officer, Information Officer and one (1) member to be selected at the annual spring meeting. The Steering Committee shall be comprised of at least one classified, one certificated and one administrative member. (Amended 9/26/08) (Amended 1/26/17)

Terms are for a minimum of two years, with three members subject to change each year, to provide consistency and shall:

1. Act as negotiating committee for the County Staywell Board.

2. Advise and give input to the Chairperson. 3. Assist with the education and promotion of health awareness and the Staywell

concept.

4. Act as liaison between the Chairperson and the member Districts.

5. Annually review insurance alternatives. (Amended 1/26/17)

6. Meet quarterly to review and analyze costs and monitor claims activity.

7. Periodically review quotes gathered by the broker/consultant for ASO services, Case Management, re-insurance and aggregate re-insurance and make recommendations to Staywell Board. (Amended 1/26/17)

8. Review annual rate calculations provided by broker/consultant.

9. Implement and enforce rules, regulations and procedures as the Board may adopt.

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10. Communicate information to Staywell Board within 120 days. (items #6,7,8,9,10 amended 9/26/08)

SUBCOMMITTEES

1. Subcommittees may be appointed by the Chairperson as deemed necessary. COMMITTEE MEETINGS

1. Committee will hold at least four regular meetings per year. (Amended 9/23/06) (Amended 1/26/17)

2. A workshop may be held at any time during the year. (Amended 9-23-06) 3. Additional meetings may be called by the Chairperson or upon the request of

twelve (12) or more members.

4. The Staywell Chief Financial Officer’s administrative support person shall distribute the meeting agenda no later than one week prior to the meeting date. (Amended 1/25/19)

5. Business at the meeting shall be conducted by a majority vote of members present.

BYLAWS

1. Changes to the bylaws shall be made by a two-thirds vote of the membership present.

2. Potential changes to the bylaws shall be communicated to the member agencies no

later than two weeks prior to the meeting at which they will be considered.

STAFF

1. There shall be one permanent non-voting staff position on the committee. This will be the Chief Financial Officer of Mendocino County Office of Education.

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2. The statistician for the group will keep records of the group’s experience. (Amended 1/26/17)

3. The Staywell Chief Financial Officer will supply the administrative support for the

group at the meetings. (Amended 2/4/11) (Amended 1/25/19) 4. The Board, based on a recommendation of the Steering Committee, will employ a

broker/consultant, once a year by the fall meeting. The specific agreement and fee shall be presented to the Board for approval. (Amended 2/4/11) (Amended 1/26/17)

5. The broker/consultant shall gather industry standard trends for medical and

prescription costs and will present the annual rate for the continuance of the past year’s plan coverage. (items 2,4,5 amended 9/26/08)

FINANCE Each member agency shall pay to the JPA each fiscal year the annual contribution approved by the Board. Member contributions will be made monthly based on payroll and deposited in the JPA fund held by the Mendocino County Treasurer. The JPA will maintain a designated stabilization fund equal to a minimum of 2-2 ½ months of premiums (or approximately 12-15% of paid claims). (Amended 9/26/08) (Amended 1/25/19) EXPANSION POLICY The policy is to expand the Staywell group through both invitation and requests, to include educational agencies in Lake, Mendocino, and Sonoma Counties. (Amended 2/15/96, 9/23/06)

1. Qualification Process Potential members must receive current insurance carrier’s approval. Through Census data and actuarial studies to be completed by the carrier, a recommendation will be made to the Staywell Committee.

2. Acceptance

A two-thirds majority approval of the Staywell Committee of the eligible membership present is required. (Amended 2/15/96)

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3. Rate Structure The broker/consultant will determine the rate structure (premium and surcharge) to be levied for the first year of membership in the Plan. At the discretion of the Staywell Committee, the group may be required as a condition of acceptance, to make a one-time contribution to the Staywell stabilization fund. (Amended 9/29/95) The new agency must buy fully into the stabilization fund with a prorate share for each eligible member based on the prior year-end balance of the stabilization fund. The payment may be made over a one-to three year time period. (Amended 2/15/96) After the first year, the group will pay the same rate as all other members (first years’ experience will be factored in with all other agencies experience).

4. Membership Effective Date

Membership in the Staywell Plan will commence with the start of the contract year (July 1). Additional administrative costs may be incurred if a group is unable to commence enrollment.

5. Obligation to Staywell

Membership in the Staywell organization obligates an agency to financial support of the Staywell Committee budget, to regular attendance and consistent representation at the Staywell meetings, and to the “Staywell concept” and goals established by the Staywell Committee including maintaining local Staywell Committees.

6. Out of County Participants

Administrative costs shall be negotiated with the County Superintendent on an annual basis. (Expansion Policy Adopted May 29, 1986. Amended February 4, 1987, September 23, 2006)

ANCILLARY GROUPS Presently covered ancillary groups may continue their membership in the Staywell insurance program if their status changes with the following conditions:

1. They continue to devote the major portion of their time to serving school districts in Mendocino County.

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2. They will not be entitled to voting representation on the Staywell Committee.

3. They accept all the obligations of membership equal to any school district

participant.

4. They shall continue to maintain the internal Staywell policies of their current agency affiliation.

If the ancillary group (entity) fails to continue to provide a major portion of their activities to support school districts, they shall become ineligible to continue membership in the Staywell group. (Amended 5/28/92) VOLUNTARY TERMINATION (Added 2/15/96)

1. Agencies opting to drop out of the Staywell JPA must give notification by February 1 and give final determination by April 15 to enable the group to receive insurance rates and quotes by May 1. This recession is binding. Agencies that have left the program will be excluded from re-enrolling for two years. (Amended 9/23/06)

2. If an agency leaves and the stabilization fund is not sufficient to pay the remaining claims of the agency, that agency is indebted for their pro-rata share.

3. When an agency leaves the Staywell JPA, they leave as a whole, including totally disabled – not at work, COBRA and Retirees.

INVOLUNTARY TERMINATION A member may be involuntarily terminated from the Staywell JPA at any time upon a vote of two-thirds of the Staywell Committee. Involuntary termination shall have the effect of eliminating the party as a signatory of the Joint Powers Agreement and as a member of Staywell, effective at the end of the fiscal year in which the action is taken or upon such other date as the Staywell Committee may specify. Grounds for involuntary termination include but are not limited to the following:

1. Failure or refusal of a member to abide by an amendment that has been adopted by the Staywell Committee as provided in the agreement of these bylaws in the area of:

a. Administrative Policies

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b. Insurance Company c. Payment of Premium

ENFORCEMENT PROCEDURE Prior to the action to involuntarily terminate any member, the Staywell Committee or Steering Committee Shall:

1. Give notice of non-compliance indicating the steps necessary to comply and allow 30 days to respond. (Amended 9/23/06)

2. After 30 days, a second notice of non-compliance will be sent and a 10% monthly surcharge shall be levied upon the monthly premium. The surcharge shall be paid to the Staywell JPA.

3. If these actions do not bring the member into compliance, then notice shall be given that the Staywell Committee will approve the involuntary termination of the member at the next regular meeting of the Staywell Committee.

STAYWELL POLICY ELIGIBILITY

1. Eligibility and status for July and August coverage shall be determined by the September assignment.

2. Short term (less than 50% of the effective FTE term) and substitute employees may

be eligible for coverage if they meet the new ACA definition of full time employee. A full time employee is someone who averages 30 hours a week or 130 hours per month for the year, you must exclude summer in the calculations. All school year employees would use 10 months to average their assignment.

How to calculate a full time equivalent, example: Substitute teacher who works 150 days in a school year would not qualify. 150 days x 7 hours = 1050 hours, divided by 10 months = 105 hours per month or average 28.4 hours/week. (Does not meet the 130 hours per month or 30 hours per week eligibility criteria.) (Amended 10/5/18)

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Substitute teacher who works 30 hours per week in a school year would qualify. 37 weeks (school year) x 30 hours = 1110 hours (Meets the 30 hour per week and length of service criteria.) (Amended 3/11/16)

3. Any employee working 50% of full time or more should be offered the health plan.

(Amended 3/11/16)

4. Each employee working 85% of a full time assignment (certificated/classified) shall be enrolled in the Staywell Health Plan. (All assignments are given credit for the time not worked in the summer/10 month.)

Examples: Certificated school year employee – 1.0 FTE = full time/10 months Classified school year employee – 1.0 FTE = 8 hours/10 months Classified employee – 1.0 FTE = 8 hours/12 months (Amended 3/11/16)

5. Employees moving from one Staywell district to another shall do so with no lapse

in coverage. The hiring district shall be responsible for additional premium. (Added 2/13/92)

6. Since all eligible employees must enroll in Staywell, employees whose spouse or

domestic partner works in a participating Staywell District with both employees enrolled in Staywell, will (each) receive a 12.5% discount on their monthly premiums. (1st reading 1/25/19) (2nd reading 3/21/19)

7. Members that reach age 65 or older may opt out of Staywell to participate in Medicare. They may not opt out for any other reason. (1st reading 1/25/2019) (2nd reading 3/21/19)

8. Staywell benefits cannot be offered to anyone that does not meet the eligibility criteria as outlined in the Staywell Bylaws. Staywell benefits can only be offered to employees (and qualifying substitutes) that meet employment eligibility. (1st Reading 3/21/2019)

RETIREES

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Retiree Staywell coverage is only offered to Staywell members who have retired from service with STRS or PERS. Staywell coverage for retirees or retiree’s spouse shall cease when the individual becomes eligible for Medicare (age 65). An individual Medicare supplement will be available to retirees through Blue Shield. The dependent spouse of a Medicare eligible retiree shall be eligible to continue with Staywell as a retiree. If the Staywell member retires after becoming eligible for Medicare (age 65), the dependent spouse shall be eligible to continue with Staywell as a retiree (until eligible for Medicare (age 65). (Amended 1/26/17) DEPENDENTS

1. The dependent child of a Medicare eligible retiree shall be eligible to continue with Staywell consistent with the benefits required under COBRA (up to 36 months at COBRA rate). (Amended 1/26/17)

2. A dependent is anyone:

a. Legally married to the Participant b. The Participant’s domestic partner c. A child, under the age of 26, who is the biological child of, adopted by, or in

legal, non-temporary guardianship of the Participant, spouse, or domestic partner.

Note: Children of dependent children (i.e. grandchildren of the Participant, Spouse, or Domestic Partner) are not considered a dependent unless Participant, Spouse, or Domestic Partner adopts or is the legal guardian of the grandchild. For more information on what is considered a dependent, please see the definition section of the Blue Shield Explanation of Coverage Booklet. ENROLLMENT

1. Coverage shall begin on the thirty-first day following the first date of service.

2. Employees working less than 85% of full time who must pay a portion of their benefits may enroll during the first 31 days of employment with coverage to begin on the 31st day.

3. A person enrolling in the plan shall be enrolled for the remainder of the fiscal year unless they no longer meet the eligibility requirements or, they leave employment. (1st reading 3/21/19)

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4. An employee that is less than .85 FTE who has voluntarily participated in Staywell and who has voluntarily dropped or elected to not be covered by the health plan shall be ineligible to enroll (re-enroll) unless they have a qualifying event as outlined under HIPPA guidelines, or at the next open enrollment period. (Amended 1/26/17) (1st reading 1/25/19) (2nd reading 3/21/19)

TRUSTEES, SCHOOL BOARD AND COUNTY BOARD MEMBERS

1. Such elected officials who have been covered by the Staywell health plan shall only be eligible for benefits required under COBRA upon leaving active status on their respective board. (Approved 5/19/89, Amended 2/15/96)

2. If the district provides the same paid health coverage as full time employees for

active trustee/board members, all such members shall be enrolled. (Amended 2/15/96, 9/23/06).

STAYWELL Mendocino County School District Health Plan

2019-2020 COMMITTEE MEETING DATES DRAFT

(Friday Meeting Dates)

Full Committee

October 4 or 25, 2019 9:30 a.m. – 12:30 p.m. River Room January 17 or 31, 2020 9:30 a.m. – 12:30 p.m. River Room March 20 or 27, 2020 9:30 a.m. - 12:30 p.m. River Room May 1 or 8, 2020 9:30 a.m. – 03:30 p.m. River Room May 22, 2020 9:30 a.m. – 12:30 p.m. River Room

Steering Committee

September 19, 2019 9:30 a.m. – via phone Discuss October Agenda October 4 or 25, 2020 8:30 a.m. - 9:30 a.m. East Room January 9 or 16, 2020 9:30 a.m. – via phone Discuss January Agenda January 17 or 31, 2020 8:30 a.m. – 9:30 a.m. East Room March 5, 12, or 19, 2020 9:30 a.m. – via phone Discuss March Agenda March 20 or 27, 2020 8:30 a.m. - 9:30 a.m. East Room April 23 or 30, 2020 9:30 a.m. – via phone Discuss May Agenda May 1 or 8, 2020 8:30 a.m. - 9:30 a.m. East Room May 14, 2020 9:30 a.m. – via phone Discuss May Agenda May 22, 2020 8:30 a.m. – 9:30 a.m. East Room

Draft – 3/21/19