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HSS board adopts 2018 City Plan administrative fees, approves Real Appeal and reproductive resource services
Summary
The Health Service System board approved a revised administrative‑fee package for the City Plan for the 2018 plan year, accepting a 3.4% net administration increase and two UnitedHealthcare programs — a year‑long Real Appeal weight‑management program and reproductive resource services — after Q&A and a public comment on co‑pays.
The Health Service System Board voted unanimously to adopt UnitedHealthcare’s administrative‑fee proposal and two new member services for the City Plan in the 2018 plan year. The board accepted Aon Hewitt’s revised materials showing a 3.4% overall administrative‑fee impact and approved proceeding with UnitedHealthcare’s Real Appeal weight‑management program and a reproductive resource services program.
Aon Hewitt’s presenter outlined fee components and the revised net impact after negotiation. “The correct number is overall 3.4%,” he said during the meeting after board members flagged a discrepancy in distributed materials. UnitedHealthcare’s account team described the Real Appeal program as a 52‑week, claims‑billed clinical weight‑management program that the presenter said averages about $300 per participant per year and that “we do not bill a claim unless that member is being successful, and they’re on target.” Reproductive resource services was described as a clinical nurse case‑management resource for members dealing with infertility.
Commissioners pressed staff and vendors on eligibility, cost and benchmarking. Board members asked whether the Real Appeal program met CalPERS diabetes‑prevention standards; UnitedHealthcare confirmed the program can meet those requirements and offered to supply additional clinical details. Members also sought clarity about the percentage change in administrative fees; Aon Hewitt and HSS staff confirmed the revised packet on the dais and the website showed 3.4%.
Herbert Weiner, a retiree, raised public‑comment concerns about co‑payments in the PPO and called attention to UnitedHealth’s corporate profits; he also disclosed ownership of UnitedHealth stock. The board acknowledged the comment and invited him to leave a written statement with the secretary. Despite the public concern, the motion to adopt the fees and benefits passed unanimously.
The board directed staff to reflect the approved fee schedule and the two programs in plan materials and to return with any implementation details that affect member out‑of‑pocket costs or eligibility rules. The approved action will be used in final rate development and communications for open enrollment.
