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SFHSS approves 2020 medical and dental rate renewals for Blue Shield, UHC and Kaiser
Summary
The Health Service Board approved 2020 renewals across major SFHSS plans: Blue Shield combined increase ~1.9% (Access Plus 2.3%, TRIO 0.9%) with two enhancements (expanded retail pharmacy vaccinations; four nutritional counseling visits), UHC City Plan up ~10% with a reduced family in‑network OOP maximum, and Kaiser insured premiums up 5.9% (includes 1% federal insurer tax).
The San Francisco Health Service System Board approved a package of 2020 renewals for the system’s major health plans on April 16, 2019, after presentations from Aon and plan representatives and public comment.
Blue Shield: Aon presented a combined renewal recommendation for Blue Shield of California totaling 1.9% (2.3% for Access Plus, 0.9% for TRIO). Staff sought and the board approved two modest plan design enhancements: expanding availability of certain ACIP‑recommended vaccinations at retail pharmacies (estimated annual savings cited at about $125,000) and offering up to four nutritional counseling visits per member annually without requiring a specific diagnosis. Board members requested follow‑up reporting about pharmacy vaccine documentation and EMR integration, particularly for minors.
UnitedHealthcare (City Plan PPO): Aon recommended and the board approved a renewal that produces roughly a 10% increase in City Plan rates for 2020. A related plan design recommendation lowers the in‑network family out‑of‑pocket maximum from $12,700 to $7,500 (set to twice the single limit) to align the family/single ratio with other plans. Staff explained part of the increase is due to the unwinding of prior rate stabilization balances that supported 2019 rates.
Kaiser Permanente: Aon recommended a 5.9% insured premium increase (4.9% underlying medical/prescription trend plus a 1% reinstated federal Affordable Care Act insurer tax). Kaiser representatives said they would adjust rates if the federal tax were rescinded before contract effective dates and would reconcile afterwards if necessary. Board members also discussed a Kaiser alignment of infertility diagnostic cost‑sharing from a $20 co‑pay to 50% coinsurance to match existing coverage levels for higher‑cost procedures; staff will provide more detail on member cost impacts.
Across the presentations, board members and public speakers raised several cross‑cutting issues: pharmacy transparency and potential effects on rebates, member navigation of second‑opinion processes, equity of fertility and assisted‑reproduction coverage for different family structures, and data and interoperability concerns for vaccination records obtained at pharmacies. Staff committed to follow‑up research and to obtain additional plan‑level utilization data where needed.
Motions to approve the Blue Shield, UHC and Kaiser renewals were moved, seconded and adopted by the board during the meeting.
