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SFHSS limits dental RFP to active members, rejects over‑the‑counter benefit on cost grounds
Summary
SFHSS staff told the Health Service Board that the dental request for proposals (RFP) will cover only active members for plan year 2027, retiree dental will be marketed for 2028, and the board declined to add an over‑the‑counter drug benefit due to a $2.20 per‑member‑per‑month cost.
At the Sept. 11 Health Service Board meeting, Executive Director Ray Guillen and staff described ongoing procurements and benefit decisions affecting dental coverage and other potential benefit additions.
Guillen said SFHSS will limit the dental RFP for plan year 2027 to active members because of time and resource constraints; the retiree dental plan will be marketed separately for plan year 2028. The department has worked with Aon on an insurance market analysis and released an online survey of active PPO dental enrollees; Guillen said the survey had received over 2,400 responses as of Sept. 5.
Guillen also reported that staff reviewed proposals from carriers to add an over‑the‑counter (OTC) benefit that would provide a per‑member allowance of roughly $70 for items such as vitamins and pain relievers. Staff decided not to bring the OTC option forward to the board because the carriers’ cost estimate was about $2.20 per member per month (PMPM) and adding that cost would apply to all members whether they used the benefit or not.
Guillen reminded the board of an ongoing blackout period for the COBRA and FSA administrator procurement while the RFP and rates/benefits processes are completed. He said staff reached out to a Blue Shield contact to assist an overseas member who reported trouble accessing benefits and that assistance had been provided.
Why it matters: restricting the dental RFP to active members and deferring retiree procurement affects service timelines for retirees; the decision not to add an OTC allowance reflects a board‑level cost/benefit choice about universal plan changes and their PMPM budget impact.
Guillen also provided personnel updates: two longtime member services staff retired in August; SFHSS made immediate offers to candidates for those positions and is continuing recruitment for benefit technician, chief financial and affordability officer, and enterprise systems and analytics director positions.
No formal board vote was taken on the OTC benefit; staff said the decision not to present the benefit recommendation to the board was made by staff because of cost.
