a. LDI Direct Contract, Health Insurance Review, Delta Dental, Zyrtec;Tom Brown 10 b. Approval/Purchase/Bid Staff Vehicles 106 MINUTES OF A REGULAR MEETING OF THE BOARD OF DISTRICT OF ST. LOUIS COUNTY, MISSOURI, HELD ON Directors of the Monarch Fire Protection District of Saint Louis County, Chesterfield, Missouri, met at the Administration Building, of said District, 13725 Olive Boulevard, in the City of Chesterfield, County of Saint Louis on Monday, April 7, 2008, at 7:00 P.M. and called to order 7:00 P.M. At the above time and place there were present the following Officers and Directors: Rick Gans-President/Chairperson and Director David Terschluse - Secretary and Director Kim Evans - Secretary and Director Assistant Chief Les CrewsAttorney Michael Bakewell called the meeting to order and announced the Board of Directors meeting to be in session for the transaction of any and all business to be open meeting of the Monarch Fire Protection (Whereupon, all persons in attendance stood and repeated the Pledge of Allegiance, after which, the following proceedings were had.) AApproval of Agenda,@ are there any changes for Report, Aa.,@ I=d like to add AAmended MOU.@ report. I=m going to add item Ac., House Four Up- to announce that the Board does accept citizen comments, is interested in what you have to say; if you=d like to speak, we ask you to fill out a speaker=s card, which are available outside door, and although it says on there, there=s a three minute limit, the Board does not keep track of the time. We just ask you to keep your comments brief and keep in mind the Board will not be drill about what to do with the mic, so I won=t was, I want to know what happened to our Citizen the Board of Directors. I believe one of the a e-mail from one of the people on the Citizens Advisory Board, saying that the Citizens Advisory Board was going to be suspended until the audit tonight=s agenda, I can see that there=s a lot more items that we can be discussing and working on and, you know, getting information back and forth, for the Board, than -- than just the from me, as a member of the Citizens Advisory Board, to persuade those that are blocking this, communication open, fulfilling the purpose and the goal and the mission of having a Citizens this committee. We need a Citizens Advisory Board that is functioning and not snoozing.
I reside at 826 Judson Manor Drive in Ward I, Chief Biele, it is me. It is I. Assistant Chief Crews, staff members and the fire fighters.
election, when the people will exhibit their preferences for who should follow their mandates.
learned a great deal about a union of fire fighters who no longer resemble the fire fighters equipped and not paid to serve their neighbors.
family matriarch, who gave all she had to serve all her generations of family and their friends.
that she may leave this earth with only a widow=s mite, but she filled our hearts as we taught -- as she taught us to love and serve each other.
speaking to was not with me to be reminded of else, the listener is evaluating you as well as facts surrounding whom you are attacking.
the disrespect you show for our elected Board.
and rich life, under less danger than highway workers, who put up signs, St. Louis Police, pizza delivery people and the list goes on and to insult, embarrass, belittle and use name calling at our Board, means you are doing the that -- that, of you. But, we will believe it, union endorsements and gifts, your effort to buy more officials to serve you works this time.
victory. It will help expose you and what you from the old school of trying to help your neighbors and wanting to be fair with all who can, when you decide to show a helping spirit.
have ALDI Direct Contract, Health Insurance Review, Delta Dental, Zyrtec, Tom Brown,@ and see that you have others with you, so I=ll let you Brown from National Financial Services.
red folder, which included the information that go over, so I=m going to go through this fairly Director Gans asked me, since we had built up some surpluses in the dental program, if there were any things that we could do to actually improve the program, relative to benefits.
basically over-viewed some of the things that we could do and the relative costs associated with numbers, our basic coverage is broken down into basic, mental -- basic. There=s preventative, basic, major and then orthodontic, which we also listed, what we currently cover for those procedures and then if you were to increase those coverages by, let=s say, an additional ten percent, what the additional -- and 20 percent, what the additional dollars in actual claims deductibles if we were to lower the -- the individual deductibles, right now, are 25 for individual and 75 total for family and if we went to a zero deductible program, what those relative numbers would cost the plan on a monthly basis.
kind of a wellness program for -- for dental, if There are bone-graft coverages and sealant coverages, which I=ve listed all of those and the -- the appropriate amounts of additional costs to the plan if we were to implement any of those being gathered, in the medical community, which basically says that a lot of, even major health related type problems, can be more quickly and earlier identified, by the gum disease and other things going on inside your mouth, that there=s really a preponderance of evidence now that -- that the dentist can, in fact, I guess, prognose, possibility that there=s some additional things brochure in your -- in your -- in your book. It=s AHealth Smiles@ is about and the whole process and we were to increase coverages in those areas.
book. I just have copies of what I sent you, so that would be in under attachment two then.
sure that I=m clear about what we=re looking at.
preventative dental procedures are covered a described, in our books, as routine exams twice a Emergency care, as needed and space maintainers for the average person, I guess, is fillings? get into major services, which are bridges and other -- other items that are considered a major because it=s paid at a hundred percent, -- saying that we are paying, right now, about two thousand a month more than the premiums are approximately, 2,000 a month. And you could really pick and choose any of these items.
the additional ten percent on major services and make that 60 percent and then go with the AHealthy Smile@ program and do the sealants.
it=s kind of a laundry list, if you will, of things that you could do to -- to get to that -- that prompted me, that I had in mind, was the basic. The things that fall under basic.
cost of basic, to even improve it by ten percent is almost double what we currently have as a not know this, but we -- we had a $100,000.00 we interested in knowing what we have built up.
to put Kelly on the spot, if she has any idea of this Board packet, so, normally, we could look. We=ll -- I even -- I will even have it myself.
morning and I -- I -- I was busy doing other passed, so I don=t really remember. But, it=s somewhere in the neighborhood of $40,000.00.
the last -- we didn=t have a financial at the last we=re adding about 2,000 a month to that.
that this is being presented. Right.
gone to the Health and Welfare Committee, -- a result of me asking, can we improve the benefit we -- we could make that assumption, Tom? - it -- the numbers would be relative.
-- I believe Delta Dental would do an odd percentage, you know, 55 percent, 65 percent.
into that, before, but we could certainly check.
tell you, I would sure like to be able to increase the basic dental by the ten percent.
number that I had in mind, when I asked Tom about would be something we could increase to a hundred percent coverage, but I can see here, it=s clearly not. It=s about three times what -- more than three times what we=re throwing off as access.
month, plus another 1600, that would last us a couple of years, based on the reserves we have, something I would like to see and then it can be taken back to the Health and Welfare Committee long as it goes to them and, maybe, they have other suggestions, but I didn=t -- I wasn=t really sure how often that committee meets and whether this would be a good time to have them discuss this and any other health -- health insurance When -- when they want to meet with us, or we that even comes to mind is orthodontia is always -- it=s always expensive to the person who=s paying out of their pocket and I don=t recall, exactly, what our reimbursement is on that after I started, we added it with a cap of benefit is 50 percent up to a max of 2,000.
I was even thinking of orthodontia, is because it=s, like, $4600.00, these days, to get braces.
that allowable reimbursed to maybe a larger number, might be another way to spend it.
difference is, I mean, I think that the basic dental covers more people than orthodontia.
the child orthodontics. When we added the adult orthodontics, that was not -- I would say, it wasn=t well received. No one really cared.
the committee has to say. Dave, I think that=s you that meets with them? Right? Health -- back to them and let them know of our interests, what we have to work with here and, you know, again, I=m interested in the possibility of -- I think we can get the basic dental up ten percent, using reserves, using the current excess.
unfortunately, a lot of this is relative to your personal situation, and -- and as I read about implants, bone grafts and sealants, those don=t mean anything to me, but it doesn=t mean they=re to mean something, but they=re -- they=re items that I=m not familiar with. And the committee may the Health and Welfare Committee and get their thoughts on it and -- and take a look at using the additional premium to fund some benefits.
Pharmacies, I asked him to come this evening.
of the form -- or, it=s basically over the counter taken off the formulary, because I actually called Walgreens and was able to find the same Zyrtec prescription that a member would have to the member, or for the plan, to be involved with a prescription that you can buy cheaper over the counter than you can, even through the lowest co- pay, that you have, with the -- with the medical exception to that. I know that there=s a lot of different kinds of Zyrtec, but the -- the overall cost, for over the counter, is less than the -- than the -- the co-pay of $8.00 that we currently that particular things, which needs to be executed, of course, by the Board, based on whatever decision you decide to make.
them? Because I read them and didn=t quite follow if you just want to cover the three options for say, AExclude them from coverage,@ does that mean that it wouldn=t be on the prescription list and they could only -- if they wanted it, they=d buy what the first one says. Is to remove it -- the first option says to remove it from the -- the plan, at the covered co-payment and make it available to the participant over the counter, think it benefits the District, because they=re no longer -- they=re no longer going to be paying for it=s less than their lowest co-payment.
discount off of our total pharmacy benefit? Aanasadate@ (sic) antihistamines, which Zyrtec fits into is a -- is a low cost, low utilization says, AInclude coverage of Zyrtec and Zyrtec-D over the counter formulations@ at co-payment.
Fire Protection will cover the over the counter decide to cut -- and I=ll give you an example I don=t want to pay out of pocket, rather.
know, what else can you put me on that=s covered is probably five times more expensive, but it=s covered under a co-payment, so, I think this -- this gives plans an option, but, if you think about it, Claritin=s been generic for quite some time, Allegra has a generic out there.
footsteps of what the plan has done already.
you -- give you the ability to cover this drug at co-payment through the medical insurance.
thinking about that, an employee would, say, if they say that to their doctor, they would end up paying $8.00 for Flonase. Is that what eight -- for that and they would get a medicine that=s equal to what they could pay six or seven dollars for, that they buy over the counter.
thinking what incentive would they have.
kind of a minor issue, if I had to put it in Anasondate@ and histamines that=s out there and this is just a formality to get it in line with what you=ve done, in the past, with the other two are to cover it at co-pay, don=t cover it and the member pays out of pocket and then I think the third option says, include the coverage of a generic, so the plan will pay for a generic of the -- of this, but they won=t cover the brand or the pricing on that, Doctor Terschluse, so I=m not really sure what that is, but, typically, when the generic -- in this case, this drug has gone generic, over the counter, is going to be -- choices are cover or don=t cover it, and not covering it, it=s not going to cost the employees anything. It=s going to cost them less. It=s going to take it off the list of drugs the reason these options exist is, when Prilosec went generic and over the counter, it was more expensive to cover the OTC at a certain point in time and then as more generic manufacturers jumped in, the price started to drop.
- they may seem ridiculous. I think they sound a little ridiculous for Zyrtec, but they have a reason for certain drugs to go generic to protect the fund and also to protect the participant from paying more than what they should pay.
want to pick one, or three, but I don=t know really see any -- I mean, you know, if it=s less than the co-pay, I don=t see any point in -- be covering it. It benefits both parties if we it will go up. The costs, as it=s coming off? I -- I think it=ll follow -- Kim, it=s the same pattern that -- that Allegra and Claritin any -- anything like that, that would happen, we could add it back to the plan, too. I mean, I don=t -- I don=t see it happening, either, but, -- happening, either, but that=s a good point.
to our discussion, with the committee, since we=re going to meet, and then make a final decision? think this is something that I=d like their advice that they=re going to go along with number one, or three, >cause it seems to make sense.
something we have to do a Board Resolution, or is a Resolution, once the Board makes a decision.
four, one of the things that we=ve been talking about for a while is to do a direct pharmacy management agreement with LDI and, basically, for you. I know that there were some questions about the term of the contract, that I=ll let to the participants in any way, shape, or form.
to the District of approximately $6,000.00 a year that would be coming in the form of rebates that are currently paid to Meritain Health.
questions about the contract, or terms, or anything else, I=ll let Mister Dino answer those.
of all, logistically, operationally, will this be any different for us, for our claims processing? claims process -- processing, at all.
basis, so it just comes back to the fund, based on utilization of certain products, like, you know, Lipitor, Nexium, products like that, get a to the fund. It=s transparent to the participant. It=s just a rebate that you=re going to see -- participants, the payment that is made for the balance for the pharmaceutical is invisible it, I -- I guess, it=s hard to think of how it could be messed up, or -- or inconvenient, where working, right now, those monies are actually re- those dollars back to the -- directly to the fund, through a direct -- a direct contract.
agreement that it can be three years, but I would like the ability to terminate upon 90 days like you to review it, obviously, because we want to look for any issues that could impact us.
this, could you describe any impact it might have really only difference is, instead of Meritain signing the participation agreement, we=re signing you would get with Mike and have him review it, - health quotes overview. And this would be in Blue Cross and Blue Shield and Mercy Health Plans, on this particular go-around.
exhibit A is just a basic -- actually, it says, AThe Monarch Fire Protection District Health here is to make this a little bit more intuitive review this particular portion of this, with you, as he was able to assist me in putting this declined to quote. Did others decline to quote? major carriers that had the most representative network and that would=ve been Blue Cross and Blue Shield, United Health Care, Mercy and GHP.
coverage for out of network, or largest network Illinois. We have people living way down south. And one of the things that we=ve always tried to do, when we take a look at comparable plans, is to quote those plans that best mirror what we Hoskins, National Financial Services.
top section and point out comparisons and answer any questions you have in -- in this area here.
network and pays 70 percent out of network.
physicians and specialists, so it=s a ten dollar co-pay for primary care, fifteen for specialists, in the current plan, and it is the same for the per individual, five hundred dollars for a individual, two thousand for family.
in the current plan. Three thousand dollars, there, when you get to the family, per year. It thousand, with a three thousand dollar out-of- the out-of-pocket maximum, is that for the in- network versus the option of the PPO or out-of- deductibles, the max out-of-pocket different, if you=re using, taking advantage of your PPO benefit and going out of the network that they -- the dollars is the maximum that an individual pays you=re using out-of-network, you=re really not in your PPO. You=re either in network or out of on, what, line three, or, yeah, line three, there which means you=re not using a hospital or physician, that participates in the Blue Cross and Blue Shield network, or the Mercy network, then that=s when you have those deductibles, and only when you=re using non-network providers.
Because in-network, no deductible, no co-pay. treatment, you pay a $250.00 deductible and then -- and the plan is paying at 70 percent, so you=re going to pay 30 percent of the bill, up to a maximum of $2,000.00 out of your pocket, and co-pays, no co-insurance, no deductible, no nothing, if you stay within the benefit.
sure that I=m correct when you=re talking about question is different. The difference between line four and five, between the non-network deductible and the maximum out of -- out of deductible, up front. And then -- then, the 70 percent kicks in, so you=re going to pay that 250 maximum, in the current plan, of five million dollars and the other two plans are unlimited.
Mercy, it=s a hundred dollar co-pay.
visits and there=s a schedule the first ten, one through ten, or $10.00 co-pays. Eleven through per year, 50 visits per year for Blue Cross/Blue Shield, 90 visits per year for Mercy.
what we=re currently booking. The current plan.
and forty thousand zero-zero-nine, using these benefit schedules, and Mercy=s two-fifty-eight- this monthly premium? Like, what numbers did you use to come up with that? I assume there=s -- we have four tiers. There=s the employee, employee and spouse, employee and children only, employee current census and along with the current benefits, of the current plan, and sent that to AOkay, matching your benefits, based on 68 families and eleven individuals and the other tiers that we have, this would be the current to let Tom take over again and I=m going to pass contacted by Director Gans, late this afternoon, and he asked me if I could put together some potential savings and how those might be arrived from the carriers that had -- had quoted us, and that=s where you see the premium reduction 250, 500 dollar deductibles, the monthly premium, we match the current plan up, as closely as we can, that=s that top number of 240,000, if we then went back to Blue Cross and Blue Shield and said, AWell, what if we add a $250.00, $500.00 individual and family network deductibles. How dollar individual family deductible, it would lower the monthly cost to the District by numbers and said, AWell, what if we raised that Shield came back and said, AWell, if you went to deductible, then that would lower the monthly mentioned here on the analysis, there=s an unlimited number of options that could be used, running various combinations of deductible co- that John just passed out here, in just a minute.
major impact, or savings, to the health insurance company, ergo, that=s what=s going to lower your things, but, really, when you get to that point, the -- the numbers are not significant.
emergency room service charges, but, really, they=re -- they=re going to -- to really impact mention, too, we -- we wanted to make this as simple and straight forward as possible.
and complicated, unfortunately, when you talk about deductibles and out-of-pocket maximums, in- Signa, or, Aetna, or, Allied, there=s probably, maybe, another four or five carriers that we could actually address these quotes to, and if the Board wanted to entertain going to a much smaller network, or other things, we could sheet just gets bigger and bigger, the more least, this evening, was to give you a relative idea of what this plan would cost if you matched it up, as best as you could, with the two biggest players, relative to network, here in the St. unlimited number of possibilities that you can do with going with a carrier that has a much smaller network of hospitals and doctors and some of the other things we=ll talk about in just a minute.
taking into consideration that this is self- funded and when you -- you aren=t comparing apples commercial PPO, so then I wonder, the reserves, and when we -- if you were to transition over to this commercial plan, we have the run-out, right, to be processed and then there may be money that=s left over that somehow would bring down the costs booking in, approximately, $206,000.00 per month.
did an average, so that -- that number=s actually with that maximum claims liability, or the -- I know there=s several different ways you can would=ve had to sit with you and watch how you costs, plus the maximum claims liability, are, the $212,000.00 number. That number includes commissions, re-insurance, L -- L -- pharmacy costs, administrative costs, through -- it includes every single cost to the plan.
mention that the amount has not gone up in about 18 months and that is, perhaps, not a realistic raise it last August, because we were in a state normally -- we always had, in the previous years, added a multiplier of 12 percent, approximately, where we decided the rest of the world was at 20, when you look at the reserves, like it=s a good end of the day, you don=t really know.
look at that as a number that=s a little bit lower absolutely correct. I mean, you really don=t know what=s done at the end of the day, until you stop the plan and run your reserves out and then what=s along with these unlimited number of hybrid plans deductibles and co-pays, there=s -- there=s, right now, in the industry, there=s a, kind of a -- the -- the darling is a deductible reimbursement a HRA. We=ll talk about those in just a second.
-- it -- it takes a deductible and, obviously, lowers the premium that you=re paying to the health insurance company, because they=re on for a around and reimburses that deductible to the like a pretty good thing to do. The problem is, you=re -- you=re right back where we are in the internally or externally, and I don=t mean to speak out of turn, but I don=t think, really, Kelly would be interested in getting all of those individual, assuring that it=s a quality claim, a good claim, and then cutting checks to reimburse people for -- for those expenses that were out- potential error on my side, your side, error -- claims that -- that are being sent in, that -- that -- that are not accurate, or correct, I mean, you=re really starting to open up kind of a -- a -- an unlimited number of problems.
participants would be with it, you know, if you get to a point where you=re paying a deductible and you have to keep your receipt and then you=re scale with the vision program, but, again, I see that as possibly a potential problem.
line is, there=s over our minimal savings. I mean, we=re -- we=re talking about a -- a percent, numbers and if you run the numbers, for example, when you raise the Blue Cross and Blue Shield to a two-fifty, five hundred dollar deductible, that only impacts the overall plan by about one-point- about dramatic huge in -- decreases in the plan. I mean, they=re -- they=re -- they=re -- the Fire District set aside money to pay those would have to -- to -- to make some -- some allowance for those bills being submitted, or those return requests from the participants to ascertain what the real numbers would be, because some people might go and have a fifty dollar bill and say, AAh, I=m not gonna -- I=m not gonna in of those people that probably won=t even submit you can=t say, AWell, it=s gonna be 85 percent of what=s paid, would be -- would be reimbursable.@ idea, Dave, I don=t think, by the time you came on -- one time we had a zero and then we had a $3.00 maximum out-of-pocket for pharmacy benefits.
than that at the drug store and then keep the receipts and turn them in and they=d get reimbursed down to three percent. Down to $3.00, and it=s not the end of the world nightmare, but you=re keeping records, you=re having to turn in records, you=re bugging the heck out of the accounting department, ADid I turn this in? Was this on the last one? Was it on the one before?@ a challenge for them, I know. And -- and we -- we were profusely thanked, when that ended, because the work that that took was incredible.
talk about that here in just -- in just a minute.
the last pages that John just handed out, the -- the information that I did this afternoon; basically, what I tried to do, again, was to put know that if we go outside, based on who we currently talked to, at this point, that has a similar network, with similar coverage, that cost to the District is about $240,000.00 a month. put some -- some number on it and say, AWell, what could we do to get it to $200,000.00 a month,@ or any number that you would arbitrarily pick to be the number that the District would want to spend for their health insurance.
spreadsheet for Mercy and if we get Signa, or if we went to Allied, or any of the other companies, the smaller companies, but, now you=re talking show you one snapshot picture, if you will, and that could be applied to other companies, or other plan designs, if you so chose.
went to the two-fifty, five hundred dollar dollars a month if you went to that deductible. deductible,@ that lowers the 240,000 by $3600.00.
that would save the plan $10,800.00 a month.
deductible than that. A thousand, -- a thousand, two thousand dollars. That would save the plan, approximately, $19,000.00 per month.
give you and idea, to 20 and 25 dollars, they=re currently at ten and fifteen, that would save the was what the potential savings would be if there was any participant participation, or employee participation in the cost of the plan.
this is, as of by the plan, the census, 35 employee and spouse, eleven employee-child and on the actual utilization, and when you look at our four-tier chart, it goes from least expensive to employee to most expensive family.
gee, why is employee-child more expensive than employee-spouse?@ Is (sic) because children, generally, generate more claims than an employee- employee-child situation, where they have more than one child. It could be multiple children.
associated a charge, on a monthly basis, and what the monthly savings would be to the plan, if participants were charged those various amounts.
the premium, that saves 16,000 a month, -- for example, add that to the deductibles being increased to 500, 1,000, that=s the second level tried to do and show you in the three examples we=ve got the standard plan, that=s going to cost seventy-five hundred, one-twenty-five monthly Well, that would save us $13,125.00.
you=d drive the costs down to approximately employee share. The deductibles aren=t quite as high and that gives you a total of what the plan response to that -- to the e-mail I sent to would it -- what would it take to get this down but not least, there are HSA=s and HRA=s and FSA=s.
similar to what the participants would know as a apologize for -- for that, but I=ll point that out deductible plan where employees participate in part of the cost of the plan, because if employees are paying for part of the plan, there=s no reason to have an HSA, or an HRA, because there=s nothing to get a tax benefit on a payment participating in the sharing of the cost of the plan, and we could set up an HSA, or an HRA, for that matter, and, basically, what happens is, the money comes out pre-tax, it goes into an account, okay? And some of the companies actually issue a credit card. They do it all different kinds of to see their physician, the co-pays are not -- are covered, but then he has to go get some lab tests. And he has a $250.00 deductible. Okay? account on a monthly basis. He takes that card in and he gives them that card to pay for the that whatever they=re putting into the plan, they do get that on a tax-free basis. You=re not taxed on the amount that=s going into the plan.
basically, means that if an employee leaves, any monies that are in the plan, they take with them.
it, much, very similar, to the section 125, or there, doesn=t use it, and leaves employment, then the money goes back -- back into the -- to the it should say, on that third line there, ASavings when the Board, basically, makes a decision, if you=re going to move to a fully insured plan, then, you know, we have a myriad of almost unlimited number of options that we can look at.
a carrier that had a significantly smaller network, whether it be an Allied, or someone like that, I can tell you that the savings will be -- will probably be more significant than with Blue there=s more out-of-network claims and -- out-of-network claims, which, basically, you=re putting more back on the participants.
discussed fully insured business tonight.
I don=t think any of us have said that we=ve absolutely made a decision to move away from -- improvements over what we have, now, to stay been working on that, constantly, on-going.
weeks, I=ll be delivering, to you, your quarterly up-date that the Board requested on the self- work in progress, since we started the self- injectable=s and the open access network.
direct, is -- is, again, a perfect example of what we continue to do on a self-funded plan to make it as -- as economical as possible.
were to decide to stay self-funded, then, at renewal time, this year, as we=ve done in the past, we would be looking at additional TPA=s and looking at other Rx providers, as we=ve done in the past. Script World is a major, major player.
control costs and keep benefit levels at a very We -- we work on that, daily, I would almost say.
don=t think that there would be, unless we had some kind of major -- a major claim, let me -- let me say, 90 days. I would be more comfortable the actual process in changing over from the self-funded to the fully insured plan would take over, do we have to give 90 days notice to frankly, I know it=s in the contract, but I really believe that if -- if we could do it in 60 days and we wrote Meritain a letter and said, ALook, conversations I=ve had with them, they -- they have verbally told me that that would be - I can tell you, right now, that that would not if the Board made a decision, obviously, you want to do this on the first of the month, but if that decision were ever made and June 1st, or July 1st, that was the time line, then -- then, I=m sure we could wrap up the other piece of it ALuminous@ discussion altogether with Blue Cross? abandoned it. It=s just extremely difficult to do program, again, the last time I was at the Board, basically, the -- the response I got back was, AThis spreadsheet=s really hard to read and we although I don=t know that you could do it this year, because of the implementation.
to -- I know they won=t -- they=ll only do them first and in the first part of the year.
and the Luminous program would have to be put into a place on -- on the -- on June the 1st.
the Luminous pro -- program, though, and it=s hard for us to come back and tell you, exactly, AHere=s what it would be,@ until the Board makes some decisions on, you know, who=s going to pay that program is still a possibility, but, again, for clarity and -- and simplicity, I wanted to try to -- to -- to hone these numbers down.
and say, AOkay, Tom, you know, after long and careful consideration, we=ve decided to go to a fully insured program,@ at that point, we would fire back up the Luminous, the Allied=s, and give you every single possible option that would be available, whether it would be an HSA, or a yourself, through a TPA, so we would be prepared you that now, is -- is -- I don=t know, it=s -- it=s -- it would be a lot more paperwork than saying is, that this is pretty much the best that you=ve been able to come across, thus far, in the trying to keep the plans as similar as possible, two of you, that we have not discussed this in a while, but it is still my desire to move to fully for serious discussion, by the end of this month, we need to consider, let=s do it sooner than later, so we can look at all of our options, meet with Health and Welfare and either decide we=re going to go forward with our current plan, which I am not in -- I=m not in favor of, or make a switch to fully insured and begin the process of looking for and we=ll be asking for your in an e-mail, earlier, this is a perfect time to be discussing all of that and, certainly, to involving -- to involve the Health and Welfare bring Paul Wirth in, so that we get another perspective of what=s going -- what he sees as this open disclosure; most people, obviously, you all know, that I work for Mercy Health Plans and there=s part of me that feels, in some way, a little uncomfortable when I see just a couple options out here, Blue Cross and Mercy.
that has anything to do with the bidding, or providing any kind of information regarding new plans. I=m simply a nurse case manager.
that out there, on the record, that I was really hoping that we would see some other options, as they weren=t the lowest, out there, but, -- And, you know, I -- I remember, year=s ago, there was a health insurance company called Golden advertising and they were -- they -- they were trying to sell the masses. And try to -- and trying to -- they did a ton of advertising, trying to get businesses to go with them and health insurance is affordable for everyone, during different health insurance times.
learned what the golden rule was, and that is, their prices were about half. Their network was about half. Every doctor who every employee that looked at it; no -- nobody found their doctor on they were real doctors. But, they were doctors and they were hospitals that nobody that worked for me, at the time, and there were about a hundred, hundred and fifty employees, about a hundred and fifty, I think; we didn=t pass it around to everybody, but, it was almost -- it was almost hard to believe that there weren=t doctors for any of us, that any of us had ever used.
they all seem like they=re the same, but they final note, you know, our -- our job has always been, as brokers, to give you enough information our perspective, if the Board decides to go to a fully insured plan, whether it=s Blue Cross and Blue Shield, or Mercy, or Allied, or any plan that we pick, our -- our relationship with them Cross and Blue Shield over Mercy or anyone else.
understand, because a lot of times, you would think that you=d send this quote out and you could get 15 companies just wanting to come and run and we=re high utilizers, as they say, which, basically, means when you talk about the amount of claims that we pay out, on a monthly basis, for -- for medical and, also, for Rx, and then when you add into that, our large claim cases, that we currently have, on-going, that the new health insurance company has to take on, that=s why these other companies simply decline to financially viable for them, at this particular back, I guess, about seven or eight months ago, we only had one company that quoted.
claims, have improved, a little bit and that=s why Mercy came back to us, this time, with a quote, because the last time they, also, declined.
quotes from other smaller companies.
out very succinctly, when you do that, you=ll save where you have to find a doctor that you can communicate with. And that can be -- that can be but they were purchased by United Health Care.
business as their individual insurance arm and all group business goes through United Health mentioned; we used to do a shot-gun approach. companies that were doing the General Motor=s, the Chrysler=s, those companies, where you had 5,000 not a large group, but we=re not a small group.
- you=re in a category that is right in-between.
will not be as long. Believe it, or not, we=re Board is aware that we got good news from the ISO, the Insurance Service Organization, that the cities we serve, as opposed to the Fire District, because, now, it=s not done by fire districts, it=s done by city, have those who -- we have results from, we have better numbers to report.
taxpayers and businesses should save money on their health -- on their health; on their property insurance premiums, because the rating of the city they live in, served by our Fire which we serve most of it, the rating has gone from a four to a two, which is significant.
people in Clarkson Valley, they should enjoy, businesses in Clarkson Valley, so they=re not serve a tiny portion, as opposed to most of it, Ballwin, they enjoy the same benefits.
Chesterfield, which have also gone from a four to a three, and while that=s not a two, it=s still a directly to insurance premiums, but it relates to what should be a reduction in premium.
can do now is educate home owners and businesses especially at renewal, to make sure they=re aware of this, to see if it has any positive impact on factors may cause insurance premiums to increase, hopefully, this off-sets, if not even reduces is ten years, this is the first ISO rating that we=ve had our first ISO review that we have had and, therefore, it=s the first change in the with them and to demonstrate our improvements, involved, but John, I think, took the lead role.
was here, so we could tell him and -- and I think we will, certainly, the next time we see him, that his efforts, and it=s not a one-person effort, but his efforts, he led the effort to get recall discussions about buying a second ladder truck and replacing a pumper with a second ladder truck, and looking at the maps of the District with the circles of the ladder coverage.
overwhelming, but it -- it, essentially, from a birds eye view, shows you what kind of coverage different location, counted for the rating.
Central County, the increase from three to five cents; Central County, the dispatch agency is a County also helped with -- helped us with our subdivisions that have been built, in the past, I don=t know how many years, since the last rating, but more than ten, are in -- more and more areas that have water and are able to pass the water test, which is a big part of the ISO rating.
officer the last time we were rated. So the training that we undergo, both day-to-day in the Stations and with our Mutual Aid companies, night training, the aircraft training, that=s a big -- I give credit to all those who were involved and to the chief for leading us through this.
that the press picks up on it and we get effective date, like, when it was official? from ISO about two weeks ago and the letters that we received were the letters that went out to the mayors of all the cities announcing what their probably, we have had the letter. So, I=m sure that if someone talked with their insurance carrier, they should have that information, you probably, three cities, we=re not sure about it, with Maryland Heights and Wildwood, and those are the ones that we know that we=re probably going to have to do a tanker shuttle-type thing and it probably won=t be done for a month, or two, here and then they=ll begin getting the ratings on got some parts of unincorporated St. Louis County coming in here, also. And I=m not sure; they=ve never really mentioned that, of how they=re going out that information, also, about that.
all of the -- the staff and the fire fighters and that. It was -- it was one of my goals, when I took over as chief, some eleven, twelve years ago, to get the insurance rating down for the getting there, but without the help of all you people, out there, we couldn=t have done it. So, have to physically do a tanker shuttle, or is it part of it=s done on a computer. Some of it=s -- part of it=s done on -- actually, what they do, is we just have to do one shuttle and then they work -- put that number into the computer, what the time was and then that=s how they calculate it.
there all day and keep hauling water back and would be, is it possible, as the word gets out to the residents, that we could have a generic letter with the current cities we have, so that we could put that on our web site, they could print it off and then maybe hand it to their that they haven=t -- that the insurance company -- two of us have pointed at -- at Mister Web two cities and the unincorporated area, but that=s preliminary information that I was given, was that it was going to stay where it is and that the -- the grading is tougher, and we=ll be lucky e-mailed, and told us, I was shocked and minute, so Les is caught without a lot of work, past House Four, I=m reminded how ugly the the status of that -- of that portion of the project is tied into the detention basin work the drawings. Once that=s done, it should be done, here, in the next few days, we have to go through an approval process, through MSD and the City of Chesterfield, to get them to buy off on the actual drawings were drawn up, to put the concept of the new engineering to get the detention basins to drain, so we don=t foresee any problems, or, hopefully, any long time. It may a matter of going out to bid for the work to be we=re going to go back and also go ahead and have the additional landscaping and re-seeding of the possibility exists, but, you know, we=re still trying to push that and make it happen as quickly detention pond, the front yard, the side yard, the area except for behind the parking lot, does that have to go through this process, or, is there -- can -- why can=t we irrigate that and but most of the time, the companies involved, they don=t want to mobilize a shut-down and come be the -- the more difficult of that.
stop here, put a valve in it and then come back about that. I don=t have an answer for you, this Closed Meeting Minutes for March 6, 2008.
sorry. Virginia corrects me. That=s Volume I, for the Closed Minutes of March 6th, 2008.
With that tool, you can get it any where.
from Foster Coach Sales, Incorporated.
specifications in the amount of $218,278.00 even.
ambulance, if two units are bought at the same disbursements in the amount of $147,680.33 for Quest, I would like to see the invoice for see it, but I would like to see that.
question. It=s for training for Les, for the employees that we are sending through the car- reimbursed by MoDOT, at the successful completion speaking of reimbursements, check 910 to Weber Chevrolet for about 5300, will be reimbursed by received the check. For some reason, the insurance company sent us the check, so we already have it, so then we=re paying the Suburban that got run into, the back -- back end have 2217 running? Was that in an accident, too? disbursements, they appear to be reasonable and necessary in the conduct of the Districts state bidding statutes, or constitute installment CHIEF BIELE: None that I=m aware of.
that we accept the disbursements as prepared.
have in here is AApproval of Engine House Door remembers, that we were doing to replace the doors on, or, install doors on the bunk rooms, on existing bunk rooms that don=t have doors, in the into. You=ve got the -- the bid and the bid prices in front of you. We had two contractors who bid on -- on the replace, or putting new doors on those Engine -- on those bunk rooms.
inadvertently went ahead and opened the bids without sending them to the Board. He=s been a lot of fire districts and he just doesn=t know why he did it, but he did it. He didn=t even think about it. He just opened them.
explaining that he did open the bids.
was present, at the time. Fire Marshal Dave Nichols was there and one of our secretary=s, discussed the bids with any of the contractors, about it. He doesn=t feel that there=s a problem accepting the bid of the lower bidder, but it=s kind of up to the Board, I guess, if we want to go ahead and accept the bid, since he opened the bids and they didn=t come directly to the Board to be opened, or, to go back out for a short bid has sent back, he said if we do go out to re-bid, he would pay any additional costs that we of time, I don=t see any point in going back and tabulation sheet is the one that the architect did put together and he recommending Door Specialist, Incorporated, for an amount of go ahead? There=s some other numbers there, too, continue going over to the right hand column, you=ll see bid alternates one and two.
grade to wood doors over the metal doors.
add an additional door in the hallway at Station One that separates the kitchen from the lounge Door Services, Inc., that would bring the total bid to twenty-six thousand three-eighty-six.
House One, the -- the hallway door has nothing to reason we included that, as a bid alternate, just to see what the price would come in, to have that we=d like to have. It=s current -- if you go to House Five, they have that, now. House One does not. So that was never included in the original to separate the noise from what goes in the kitchen, to the front of that Engine House, I think that=d be a nice accommodation to put in we -- do we have wood, or metal doors, now? are -- are a wooden door in the majority of the on the separate -- the separation between the apparatus bay and the living quarters are all metal, but most of the other doors are a wood inclined to go with the low bid with the going with wood. You want to go with metal? It=s that the Board allow us to authorize to spend up to two -- twenty-six thousand three-eighty-six.
make a motion to award the bid for doors at House One to Door Services, Incorporated, for an amount eleven-forty-two is for wood doors or metal when you came out, by explaining that we had budgeted, this year, to replace two staff is Assistant Chief Les Crews 2003 Crown Victoria, which has 140,000 miles on it, and one of the inspector=s vehicles, a 2000 Crown Victoria, which and purchase another Ford Explorer for Assistant Bakewell, since the short time that we have done the bid, we took delivery in February, of those. He=s comfortable with going ahead and purchasing another one off of that bid that we=d already They=re -- they=re fine with going ahead and selling us another one, at that price, at a price inspector=s vehicles, even though there=s a vehicle on the state bid that we think we could utilize, we still need to go out and bid that.
probably, a two week bid on that, if we could -- in, we will go ahead and open that bid and then Assistant Chief Crews, it=s about a two month delivery on that and I=m not sure what the delivery would be on the other staff vehicle, until we get the bids back and award that bid.
bought before were off -- were they bought this in November, of last year, and took delivery in being an expense for >08, >cause we paid for them and we -- when they were they delivered or when Resolution to make the purchase from Lou Fusz, purchase a Ford Explorer from Lou Fusz Ford in an motion to go out to bid for a 2008 Chevrolet Impala, with bids due back two weeks after the bid is put out, to be opened, by the Board, and and, probably, give the whole thing.
passed with the understanding that at the point in which the Wright case was settled and passed the appeal period, that we would make whatever changes were necessary to bring this back to -- so that all wages were calculated based on 2,912 and ready to move forward with those changes.
has seen the -- the revision. Was that e-mailed approach that we decided to take was any point that -- that discussed the wages calculated in the alternate manner, under which we=ve been operating, that we would provide a footnote showing the wording that was deleted for that section and that the wording deletion was date, because that=s the beginning of an FLSA cycle, it makes our calculations for half time much more simplified to start at the beginning of the Board, obviously, still needs to see.
it=s fine, but I need you approval and release to forward the draft to the shop stewards, at this Unless, you=d like to see it, first.
approving. You=re just releasing the draft to the looking for, I think is what they=re looking for, and that is to put it back the way it was.
we=re all expecting and that=s, hopefully, how it some revisions, instead of how the wording was, we originally started with just deleting those sections and saying that those sections were because it sort of left a gap from March 1, to April 15th, in -- in the --the contract.
wording that was deleted. So that=s a cleaner way unrelated to the Wright issue, we are preparing the financial side, so that employees can have arose, as a result of reading the contract, that interpretation that we took, in the payroll and/or Incentive Pay for an employee who is an acting captain, acting EMS supervisor,@ and the wording in the MOU says, Aand an acting assistant that it=s Aand/or@ any of those three positions.
that none of them could get paid, if you had to Resolutions on these things, as we go through in front of me. I gave it to Jason to make mean Aand/or@ any of those three positions.
Board just confirms that, yes, that is their interpretation, of it, that that=s sufficient.
you to make that change, as the consensus of the Board is to make that to an interpretation of clarify is in the salary section. The very first paragraph talks about any new hires would come in that we do mean to include all of those employees hired today, to get a better step-raise than an there. We=ve interpreted it to mean to apply it to all employees hired since January 1, 2004, and I just wanted to clarify with you that that was Resolution on that in closed session, did we? that in closed session, though, and did come to a consensus that your interpretation is correct.
interpretation of having everyone who=s in the step process be in the most recently passed step we will not be making any changes to the actual discussion, but we will use the transcript of the Minutes to include in the payroll files, so that we know that we=re doing what the Board intended - So that=s all I had related to that.
Resolution for the first thing she brought up? good report, Mike. That=s the best one you=ve this. ASelection of May and June Meeting Dates.@ month. On the 24th is an open meeting and in -- if we stay with Thursday=s, in May there are five right in with the first one, on -- a Closed DIRECTOR GANS: Yeah, it=s the fourth.
29th and move to June 5th. Let me make sure I Monday, because Tuesday=s are bad for me.
9th. That works for me. So we=ll do an open session on the 9th. Is seven o=clock okay, Dave? County meeting and it is Aall Directors invited@ that day, at 5:30 on the 26th of June and then, brief -- okay. So, the agenda this meeting calls into a Closed Meeting under 610 -- under RSMo 610.021, One, Three, Thirteen, Two and Nine.
Session at the conclusion of the Closed Meeting, recessed for a Closed Meeting, after which, at 9:11 P.M., the following proceedings were had.) the Open Session of the Monarch Fire Protection (Whereupon, the meeting was adjourned at STATE OF MISSOURI ) ) SSCOUNTY OF ST. CHARLES ) and professional court reporter, within and for the State of Missouri, County of St. Charles, do hereby certify that there came before me at that time and in that place first aforesaid, those persons and matters herein described, and has been transcribed into typewritten form by me and set my hand and seal this 7th day of April, 2008.
My commission expires June 14, 2008.
________________________Notary Public within and for the State of Missouri



Data and Safety Monitoring During Randomized Controlled Trials of Nursing Interventions Nancy T. Artinian ▼ Erika Sivarajan Froelicher ▼ Background: Principal investigators have a responsibility to ensure and maintain the scientific integrity of their research studies and to protect the safety of the partici-pants. Data and safety monitoring is required for all types of c

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International refereed journals (first author) van der Stelt, O., Gunning, W. B., Snel, J., Zeef, E., & Kok, A. (1994). Children of alcoholics: Attention, information processing and event-related brain potentials. Acta Paediatrica, 404 (Suppl.), 4-6. ISSN 0803-5326. van der Stelt, O. (1994). Caffeine and attention. Pharmacopsychoecologia, 7(2), 221-227. van der Stelt, O., Gunning, W. B.

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