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Board approves 95¢ PMPM boost to sustainability fund to expand wellness, audits and eBenefits
Summary
The Health Services Board raised the Health Care Sustainability Fund charge from $2.05 to $3.00 per member per month to support personnel costs, website and eBenefits improvements, wellness programming and expanded operational audits; the measure passed 4–2.
San Francisco — The Health Services Board approved a 95¢ increase in the Health Care Sustainability Fund per-member charge, raising it from $2.05 to $3.00 per member per month for the 2017 plan year. The change is intended to generate roughly $750,000 annually to support ongoing wellness work, web and eBenefits enhancements, personnel cost increases and expanded operational audits.
HSS staff summarized the history of the PMPM charge and explained that ongoing expenditures have been growing faster than revenues, leaving little room for new or expanded initiatives without an increase. Staff highlighted work already underway — including All-Payers Claims Database integrations and communication plans — and said the additional funds would permit targeted one-time investments and modest recurring expansions in wellness and compliance activities.
Commissioners debated whether the increase should be borne by members via the rate card; staff clarified that the line is an administrative charge on the rate card and that MOUs and employer/employee premium-sharing rules determine actual member payments. The board approved the increase 4–2; staff will incorporate the charge into rate cards and disclosure materials.
