AGENDA. CCCSIG Conference Room 550 Ellinwood Way Pleasant Hill, CA (866)

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1 I. CALL TO ORDER AGENDA CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP March 18, 2016 Lunch 12:30 PM 1:00 PM Meeting 1:00 P.M - 3:00 P.M CCCSIG Conference Room 550 Ellinwood Way Pleasant Hill, CA (866) II. ROLL CALL & INTRODUCTIONS Bylaws of the Contra Costa County Schools Insurance Group I.G.4. Quorum. A majority of each Committee membership shall constitute a quorum for the transaction of business except that less than a quorum may adjourn from time to time. Member Districts = 7 Number required to achieve a quorum = 4 CCCSIG: Contra Costa County Schools Insurance Group Bridget Moore, Executive Director MEMBERS: Brentwood Union School District Margaret Kruse, Committee Chair ` Brentwood Union School District Debbie Valladao, Alternate Byron Union School District Wendy Richard Byron Union School District Tina Pedersen, Alternate Canyon School District Gloria Faircloth Castro Valley Unified School District Candi Clark Castro Valley Unified School District Robin Yearby, Alternate Moraga School District Kathy Bell Moraga School District Courtney Avellar, Alternate Oakley Union Elementary School District Michele Gaudinier, Vice Chair Oakley Union Elementary School District Cindy Peterson/Tammi Lauderdale, Alternates Walnut Creek School District Kevin Collins Walnut Creek School District Cindy Lannon, Alternate CONSULTANTS Debra DeSpain Vickie Vales III. PUBLIC COMMENTS Comments from the general public will be received and limited to five minutes per person.

2 IV. APPROVAL OF AGENDA Action The Committee retains the right to change the order in which agenda items are discussed. Subject to review by the Committee, the agenda is to be approved as presented. Items may be deleted or added for discussion only according to G.C. Section V. APPROVAL OF MINUTES February 19, Action The Committee will review the minutes of the last Committee meeting for any adjustments and adoption. VI. CORRESPONDENCE Correspondence will be presented and reviewed by the Committee. No action may be taken in response; only referred for action on a subsequent agenda. VII. UNDERWRITING PREMIUM AND CLAIMS REPORT The Premium and Claims Reports for the Health & Welfare Program are presented on a quarterly basis. VIII. ADMINISTRATION/HEALTH BENEFIT PROGRAM ADMINISTRATIVE UPDATE 2017 Carrier Options Sutter Health Plus, Aetna New Business Travis Unified School District Anthem Blue Cross Override Consulting Agreement Amendment IX. INFORMATION MEMBER COMMENTS Each member may report about various matters involving the Committee. There will be no Committee discussion except to ask questions, and no action will be taken unless listed on a subsequent agenda. CONSULTANT COMMENTS The Consultant will report to the Committee about various matters involving the Committee. There will be no Committee discussion except to ask questions, and no action will be taken unless listed on a subsequent agenda.

3 LEGISLATIVE UPDATE/BRIEFING The Consultant will present Legislative Updates/Briefings/Articles of Interest to the Committee. X. AGENDA ITEMS NEXT MEETING Members and others may suggest items for consideration at the next meeting tentatively scheduled for April 15, 2016, 10:00 AM 12:00 PM. XI. ADJOURNMENT Americans with Disabilities Act: Contra Costa County Schools Insurance Group conforms to the protections and prohibitions contained in Section 202 of the Americans with Disabilities Act of 1990 and the federal rules and regulations adopted in implementation thereof. A request for disability-related modifications or accommodation, in order to participate in a public meeting of the Contra Costa County Schools Insurance Group, shall be made to: Bridget Moore, Executive Director, Contra Costa County Schools Insurance Group Ellinwood Way, Pleasant Hill, CA (866)

4 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: ACTION Approval of Agenda Enclosure: Yes Category: Prepared by: Requested by: Approval of Agenda BACKGROUND: Under California Government Code Section the Legislative Body is required to post an agenda detailing each item of business to be discussed. The Committee posts the agenda in compliance with California Government Code Section STATUS: Unless items are added to the agenda according to Government Code (b) (1) (2) (3), the agenda is to be approved as posted. RECOMMENDATION: Subject to changes or corrections, the agenda is to be approved.

5 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: ACTION Approval of Minutes February 19, 2016 Enclosure: Yes Category: Prepared by: Requested by: Approval of Minutes BACKGROUND: As a matter of record and in accordance with the Brown Act, minutes of each meeting are kept and recorded. STATUS: Included in the agenda packet are minutes from the February 19, 2016meeting, which have not yet been approved. RECOMMENDATION: Subject to changes or corrections, the minutes of the February 19, 2016 meeting are to be approved as submitted.

6 MINUTES CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP February 19, :00 A.M - 12:00 P.M CCCSIG Conference Room 550 Ellinwood Way Pleasant Hill, CA (866) I. CALL TO ORDER The meeting was called to order by Michele Gaudinier at 10:00 AM. II. ROLL CALL & INTRODUCTIONS Bylaws of the Contra Costa County Schools Insurance Group I.G.4. Quorum. A majority of each Committee membership shall constitute a quorum for the transaction of business except that less than a quorum may adjourn from time to time. Member Districts = 7 Number required to achieve a quorum = 4 Those in attendance were: CCCSIG: Contra Costa County Schools Insurance Group MEMBERS: Brentwood Union School District Byron Union School District Castro Valley Unified School District Moraga School District Oakley Union Elementary School District Walnut Creek School District ABSENT: Canyon School District CONSULTANTS Bridget Moore, Executive Director Debbie Valladao, Alternate Wendy Richard Robin Yearby, Alternate Kathy Bell/Courtney Avellar Michele Gaudinier, Vice Chair Kevin Collins Gloria Faircloth Debra DeSpain Vickie Vales III. PUBLIC COMMENTS There were no public comments.

7 IV. APPROVAL OF AGENDA Action A motion was made by Kathy Bell, seconded by Wendy Richard and unanimously carried to approve the Agenda as presented. Votes: Brentwood Aye Moraga - Aye Byron Aye Oakley Aye Canyon Absent Walnut Creek Aye Castro Valley Aye V. APPROVAL OF MINUTES January 8, Action A motion was made by Kevin Collins, seconded by Kathy Bell and unanimously carried to approve the Minutes as presented. Votes: Brentwood Aye Moraga - Aye Byron Aye Oakley Aye Canyon Absent Walnut Creek Aye Castro Valley Aye VI. CORRESPONDENCE There was no correspondence for this meeting. VII. UNDERWRITING PREMIUM AND CLAIMS REPORT This was not applicable for this meeting. VIII. ADMINISTRATION/HEALTH BENEFIT PROGRAM ADMINISTRATIVE UPDATE Kaiser Permanente Periodic Utilization Review Kelsey Leslie, Senior Account Manager with Kaiser Permanente presented the utilization report. The information provided has been collated from various reports into one overview. Highlights included: Utilization has had an overall 5.13% decrease since the renewal claims period The average age and female membership of the group is higher than the Kaiser regional average Pharmacy utilization has increased as is the trend with other Kaiser clients; one of the reasons for this specialty drugs Chronic conditions i.e., asthma, kidney disease, chronic heart failure, depression, diabetes, represent the majority of claims costs at 43.5% o Lifestyle risks obesity, diabetes, cholesterol Preventive services received by the members have increased Recommendations increase onsite wellness programs; promote wellness coaching and online programs; alternative access to care (phone visits, nurse lines, etc.), mail order pharmacy Kelsey offered to have a physician present the Chronic Conditions in more detail at a future HBC meeting and the committee agreed.

8 2015 CCCSIG HBP Member Survey Results Action Bridget Moore reviewed the 2015 HBP Member Survey results, as presented in the meeting material. The responses were very favorable scoring between 4.60 and The only suggested goal/opportunity made was to grow the membership. A motion was made by Robin Yearby, seconded by Kevin Collins and unanimously carried to accept the 2015 Member Survey Results as presented. Votes: Brentwood Aye Moraga - Aye Byron Aye Oakley Aye Canyon Absent Walnut Creek Aye Castro Valley Aye New Business Travis Unified School District Action Debra DeSpain reviewed the demographic impact analysis for the possible admission of Travis Unified School District into the Kaiser Health Benefits Program. Since Travis USD is small the only analysis is demographic as claims utilization is not available. Travis demographic factor and average age is slightly higher/older than the CCCSIG pool. There is no definitive proof that demographic factors have a direct affect on utilization. Travis does not have cash-in-lieu, however there are waivers as many of the employees have coverage through the military. Travis would enter July 1 with their current Kaiser rates and then would receive the JPA s 2017 Kaiser renewal. If they did not join July 1, they would wait until January 1 and would enter with their 2017 renewal. Kevin Collins questioned if the distance for a representative to attend the meetings would be a problem as a quorum is always a concern. Debra stated she did not think so as the management personnel are very interested in joining the JPA. The HBP should require a commitment to attend every meeting or assign their vote to another member district. Bridget reviewed the requirements to join the JPA and the timing. Debra will be meeting with Travis at their March Benefits committee meeting and discussing CCCSIG s decision and the entry requirements. Debra recommends the committee move forward with accepting Travis USD into the HBP in order to replace the loss of enrollment caused by Lafayette and St. Helena as well as to begin growing the membership. A motion was made by Kevin Collins, seconded by Kathy Bell and unanimously carried to accept Travis USD as a member of the Health Benefits Program effective July 1, Votes: Brentwood Aye Moraga - Aye Byron Aye Oakley Aye Canyon Absent Walnut Creek Aye Castro Valley Aye

9 KeenanDirect Pre/Post Tax Contributions and Retirees Because of the withdrawal of Lafayette and St. Helena from the HBC, Debra opened discussions with Anthem Blue Cross regarding the 2017 renewal. Anthem Blue Cross has confirmed they will not be providing a renewal for Based on this information, Keenan has submitted proposal requests and the census, plan and rate information to Sutter Health Plus and Aetna. Aetna has recently announced they are actively pursuing public agency prospects. Their network would be similar to Anthem Blue Cross. Debra mentioned they might even consider being offered alongside Sutter Health Plan. Keenan expects to have these quotes for the March meeting and will also bring network details for both Sutter Health Plan and Aetna. Kevin asked about the plan and rating options from KeenanDirect. Debra reminded the committee sample plans and rates were presented during the January meeting. At this point, the committee needs to think about what next steps they want to take. Basically, the options are seeing what Sutter Health Plus and Aetna can provide as well as the KeenanDirect/HRA option. IX. INFORMATION MEMBER COMMENTS None. CONSULTANT COMMENTS None. LEGISLATIVE UPDATE/BRIEFING Debra DeSpain reviewed the legislative briefing included in the materials detailing new information on affordability and flex credits. X. AGENDA ITEMS NEXT MEETING The next meeting is scheduled for March 18, 2016, 1:00 PM 3:00 PM. Lunch will be provided at 12:30 PM. Agenda items are: Options Sutter Health Plus, Aetna (including network details) 2. Everyday Acts of Kindness Initiative 3. April CCCSIG Meeting/CASBO XI. ADJOURNMENT Americans with Disabilities Act: Contra Costa County Schools Insurance Group conforms to the protections and prohibitions contained in Section 202 of the Americans with Disabilities Act of 1990 and the federal rules and regulations adopted in implementation thereof. A request for disability-related modifications or accommodation, in order to participate in a public meeting of the Contra Costa County Schools Insurance Group, shall be made to: Bridget Moore, Executive Director, Contra Costa County Schools Insurance Group Ellinwood Way, Pleasant Hill, CA (866)

10 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: INFORMATION Correspondence Enclosure: No Category: Prepared by: Requested by: Correspondence BACKGROUND: Communications received by, or sent on behalf of, the Committee is presented to the Committee. These communications are normally informational in content and no action is required except to acknowledge receipt. STATUS: There was no correspondence received for this meeting. RECOMMENDATION: For review and information only.

11 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: INFORMATION Premium and Claims Report Enclosure: Handout Category: Prepared by: Requested by: Underwriting BACKGROUND: The Premium and Claims Reports for the Health & Welfare Program are presented on a quarterly basis. STATUS: The Anthem Blue Cross premium and claims report for the period January 2015 December 2015 will be reviewed. RECOMMENDATION: For review and information only.

12 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 Full Board SUBJECT: ITEM #: INFORMATION 2017 Carrier Options Sutter Health Plus, Aetna Enclosure: Handout Category: Prepared by: Requested by: Administration Health Benefit Committee BACKGROUND: Anthem Blue Cross submitted their January 1, 2017 non-renewal notification February 19, Additional Marketing has been submitted to Sutter Health Plus and Aetna. STATUS: Aetna has declined to quote due to participation. Based upon the district census information provided to Aetna, there are approximately 80 non-kaiser enrollments, which is a 5% participation level with 95% Kaiser. Keenan will present the Sutter Health Plan options. The JPA can choose up to four (4) plans that would be offered by all district members. The districts cannot choose individual district plans. Sutter Health Plus Plan Hospitals and Providers groups are: Hospitals Alta Bates Summit Medical Center (Berkley and Oakland) California Pacific Medical Center (San Francisco) Eden Medical Center (Castro Valley) El Camino Hospital (Los Gatos and Mountain View) Menlo Park Surgical Hospital Mills-Peninsula Medical Center (Burlingame and San Mateo) Novato Community Hospital Sequoia Hospital (Redwood City)

13 Sutter Delta Medical Center (Antioch) Sutter Santa Rosa Regional Hospital Physician Organizations Brown & Toland Physicians Mills-Peninsula Medical Group Palo Alto Medical Foundation Sutter East Bay Medical Foundation Sutter Pacific Medical Foundation The current Anthem Blue Cross top Provider Groups and Hospitals are: CCCSIG - Medical Group Members AFFINITY MEDICAL GROUP 1 ALTA BATES MEDICAL GROUP 9 BROWN AND TOLAND MEDICAL GROUP 2 HILL PHYSICIANS MEDICAL GROUP 33 JOHN MUIR PHYSICIAN 129 PALO ALTO MEDICAL FOUNDATION 1 PIH HEALTH PHYSICIAN 1 SUTTER EAST BAY MEDICAL FOUNDATION - DIABLO DIVISION 5 SUTTER EAST BAY MEDICAL FOUNDATION 5 SUTTER GOULD MEDICAL GROUP 2 SUTTER MEDICAL GROUP 1 Grand Total 189 RECOMMENDATION: For review and information only.

14 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: INFORMATION New Business Travis Unified School District Enclosure: No Category: Prepared by: Requested by: Administration/Health Benefit Program Administrative Update BACKGROUND: Travis Unified School District is located in Solano County. They have approximately 500 employees and are currently a stand-alone district with coverage through Kaiser, Sutter Health Plus and Western Health Advantage. During the February 19 th HBP meeting, the committee voted to allow entry into the CCCSIG Kaiser Program. STATUS: Travis USD will discuss joining the CCCSIG JPA and HBP at their March 16 th Benefit Committee meeting. Keenan will provide an update based upon that meeting. Travis USD has been provided the membership requirements into the CCCSIG JPA and HBP. If Travis USD is interested in moving forward, upon receipt of required membership documents, CCCSIG will bring the matter to the Executive Committee for consideration. RECOMMENDATION: For review, discussion and action as necessary.

15 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 Full Board SUBJECT: ITEM #: INFORMATION 2014 Anthem Blue Cross Overrides Enclosure: No Category: Prepared by: Requested by: Administration Health Benefit Committee BACKGROUND: Per the CCCSIG/Keenan Consultant contract, Keenan will pass through any override funds for Anthem Blue Cross. In 2015, Anthem Blue Cross changed the process for determining overrides. STATUS: Keenan has been able to confirm that the final 2014 Anthem override amount for CCCSIG is $5,368. RECOMMENDATION: For review and information only.

16 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 Full Board SUBJECT: ITEM #: INFORMATION 2016 CCCISIG/Keenan Consulting Agreement Amendment Enclosure: No Category: Prepared by: Requested by: Administration Health Benefit Committee BACKGROUND: Keenan has amended the 2016 Consulting Agreement due to the withdrawal of Lafayette Elementary School District and St. Helena Unified School district. STATUS: The consulting agreement has been amended to reflect an updated consulting fee of $165, due to the withdrawal of Lafayette Elementary School District and St. Helena Unified School District. The overall total was reduced by: Lafayette Elementary School District - $22, St. Helena Unified School District - $14, RECOMMENDATION: For review and information only.

17 CONTRA COSTA COUNTY SCHOOLS INSURANCE GROUP AGENDA ITEM DETAIL PRESENTED TO: DATE: March 18, 2016 SUBJECT: ITEM #: INFORMATION Legislative Update/Briefing Enclosure: Yes Category: Prepared by: Requested by: BACKGROUND: provides their clients with updates on current and pending legislation and other items affecting school districts. STATUS: The following briefings are enclosed: 1. Health Care Reform: New Guidance on Cash-in-Lieu and Affordability Under the Employer Mandate RECOMMENDATION: For review and information only.

18 BRIEFING FEBRUARY 2016 HEALTH CARE REFORM: NEW GUIDANCE ON CASH-IN-LIEU AND AFFORDABILITY UNDER THE EMPLOYER MANDATE Under the Affordable Care Act (ACA), an Applicable Large Employer may be subject to a penalty if it does not offer its full-time employees affordable, minimum value (MV) coverage. As discussed in our August and November 2015 Briefings (see links below), waivers of coverage and cash-in-lieu of benefits raise several issues that employers must address, including new considerations introduced by the ACA. The Internal Revenue Service (IRS) recently issued Notice that address a key ACA issue how cash-in-lieu is treated when determining if coverage is affordable under the Employer Mandate. PROPOSED REGULATIONS FORTHCOMING The IRS stated it plans to issue proposed regulations that will require the amount offered as cash-in-lieu to be included as part of the employee s required monthly contribution for the cost of coverage. For example, assume an employer offers its employees coverage under a group health plan through a 125 cafeteria plan. The employee s required monthly contribution for the lowest cost self-only coverage that provides MV is $100 per month but employees can take $150 as cash-in-lieu of benefits. For purposes of the Employer Mandate B penalty and the related reporting on Line 15 of IRS Form 1095-C, the employee s required contribution for the group health coverage is $250 per month. This is true regardless of whether the employee actually enrolled in the lowest cost self-only coverage that provides MV or took cash-inlieu. It is true even if the employee enrolled in a more expensive plan offered by the employer. From the IRS perspective, an employee would not only have to pay $100 per month for that lowest cost self-only coverage but would also lose $150 in cash each month by enrolling in the plan, which makes the effective cost $250 per month. The preliminary guidance only addresses unconditional cash-in-lieu arrangements i.e., those not tied to proof of other group coverage. The IRS plans to address conditional cash-in-lieu arrangements i.e., those tied to proof of other group coverage in the forthcoming regulations. At this point, it is unclear how the IRS will treat those types of arrangements. EFFECTIVE DATE OF GUIDANCE The effective date for this new guidance differs for cash-in-lieu arrangements adopted on or before December 16, 2015 and those adopted after that date. Those adopted on or before December 16, 2015 will not need to comply with the new guidance until final regulations are issued. For arrangements adopted after December 16, 2015, the new guidance is effective now License No Innovative Solutions. Enduring Principles.

19 A cash-in-lieu arrangement will be treated as being adopted after December 16, 2015 unless: (1) the employer offered the cash-in-lieu arrangement (or a substantially similar arrangement) for a plan year including December 16, 2015; (2) a board, committee, or similar body or an authorized officer of the employer specifically adopted the arrangement before December 16, 2015; or (3) the employer had provided written communications to employees on or before December 16, 2015, indicating that the arrangement would be offered to employees at some time in the future. NEXT STEPS Employers with cash-in-lieu arrangements adopted on or before December 16, 2015 should: (1) begin evaluating the impact of this guidance on the affordability of their lowest cost self-only coverage that provides MV, (2) consider restructuring the cash-in-lieu arrangement, if necessary, to ensure the lowest cost self-only coverage that provides MV is affordable, and (3) wait for further guidance. As discussed above, the IRS still plans to address conditional cash-in-lieu arrangements and, at this point, it is not clear how they will be treated under the new regulations. In addition, the IRS has not provided a time frame for when proposed or final regulations may be issued; therefore, it is not clear when employers with established cash-in-lieu arrangements will need to come into compliance. Any employers with cash-in-lieu arrangements adopted after December 16, 2015 must comply with the new guidance effective immediately. Accordingly, they should evaluate the impact of the guidance on the affordability of their lowest cost self-only coverage that provides MV. If the guidance makes the coverage unaffordable, they should consider restructuring the cash-in-lieu arrangement to make coverage affordable. Please contact your Keenan Account Manager for questions regarding this Briefing or if you require any additional information regarding the Affordable Care Act. is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Clients are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the clients business activities License No Innovative Solutions. Enduring Principles.