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$6,604,372 $1,326,341 $7,930,710 4.8% Option 2 (One Plan--PPO) $6,776,097 $1,272,406 $8,048,503 6.3% Wellness Activities •Enhanced preventive services through County Health Plan (no cost to members) •Lunch `n Learn Wellness Presentations •Wellness Committee •Addition of Health Advisor program in 2009 Questions Commissioner Gordon asked about changes in vacation or leave and Michael McGinnis said that there is no change in vacation, leave, petty leave, or sick days. Commissioner Gordon asked why the HMO's no longer have gatekeepers anymore and Diane Shepherd said that the system has eroded over time. Commissioner Gordon asked how it is managed care. Diane Shepherd said that it is mainly the in-network versus the out-of-network benefit. There is no out-of-network benefit, so the users are restricted to the membership network. Commissioner Carey said that the paid claims have decreased by $85,000 over the prior year. He asked about the prior year. Michael McGinnis said that this is for the County's fiscal year. Commissioner Nelson asked how much feedback staff wanted about Option 1 versus Option 2. Michael McGinnis said that staff would be providing for October 71h a recommendation based on the input from the Board. Commissioner Nelson said that he is open to hearing from employees and other County Commissioners, but his preference at this point would be the Buy Up plan because it preserves two options. Chair Jacobs made reference to the dental plan. He said that this plan mostly covers things that are preventative and things like crowns and periodontal are barely covered. He suggested looking at this further. Diane Shepherd said that many of these services are covered at 50%. Chair Jacobs made reference to the Employee Assistance Program and said that he was glad counseling sessions were being increased from three to five. He said that, unless there is a crisis, this is just whetting someone's appetite for counseling. Michael McGinnis agreed and said that three is the lowest he had known and five is very inexpensive. He thinks that 12 visits would be reasonable. Diane Shepherd pointed out that the health insurance also covers mental health issues. Chair Jacobs asked about the co-pays on page 26. He said that if the increasing cost is hundreds of thousands of dollars, maybe a less painful way to address the shortfall is to consider small changes in co-pays. A $5 change may make a significant difference across the board. Diane Shepherd said that co-pays were raised last year, so staff was reluctant to introduce another change. Commissioner Foushee said that she got a call from someone that had a dependent child and took their child for a doctor visit, and over the next six weeks, the child had to go back for follow-up visits, and each time, she had to pay a co-pay. This employee ended up paying almost $100. She said that this employee does not have a great salary. She said that