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MINUTES OF A REGULAR MEETING OF THE BOARD OF
DISTRICT OF ST. LOUIS COUNTY, MISSOURI, HELD ON
7:00 P.M. OPEN MEETING
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
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.