Board Agenda & Materials

December 8, 2023

The San Joaquin Valley Insurance Authority (SJVIA) Board will meet on Friday, December 8, 2023 at 9:00am. The meeting will take place at the County of Tulare Board of Supervisors Chambers, 2800 W. Burrel Ave., Visalia, CA 93291.  Links below include the agenda and items being considered at the meeting.

Agenda

Click here at 9:00am on Friday, December 8, 2023 to listen to the meeting live.

Listen to a recording of the meeting.

• Item 5 - Public Comment

• Item 6 - Approval of Consent Agenda - Item Numbers 18 - 25

• Item 7 - Receive Update from Auditor-Treasurer on Cash Flow Projections

  • Item 7 Attachment - Update on Cash Flow Projections

• Item 8 - Receive Report on on the Self-Funded Medical and Dental Audit Performed by TFG Partners

  • Item 8 Attachment - Consultant's Report on Medical and Dental Audit

  • Item 8 Attachment - TFG Audit Report on Medical Claims

  • Item 8 Attachment - TFG Audit Report on Dental Claims

• Item 9 - Receive Consultant's Medical, Dental, and Vision Experience Reports through September 2023 with Update on Projected Plan Experience Surplus Accumulation and Projections

  • Item 9 Attachment - Consultant's Report on Plan Experience through September 2023

  • Item 9 Attachment - SJVIA Medical Experience through September 2023

  • Item 9 Attachment - SJVIA Dental Experience through September 2023

  • Item 9 Attachment - SJVIA Vision Experience through September 2023

• Item 10 - Receive Keenan Pharmacy Services' Consultant's Report on EmpiRx Pharmacy Utilization

  • Item 10 Attachment - Consultant's Report on EmpiRx Pharmacy Utilization

• Item 11 - Receive Consultant's Report on Plan Year 2024 Stop Loss / Reinsurance Renewal and Marketing Results and Authorize President to Execute Application and Agreement Subject to Approval of SJVIA Counsel and Staff

  • Item 11 Attachment - 2024 Stop Loss Renewal and Marketing Presentation

• Item 12 - Receive Recommendation on Self-Funded Delta Dental PPO Plan to Amend the Orhodontia Lifetime Maximum Policy to No Longer Prorate the Maximum based on Previous Plan or Carrier Payments and Authorize President to Execute Amendment Effective January 1, 2024, Subject to Approval of SJVIA Counsel and Staff

  • Item 12 Attachment - Delta Dental Amendment No. 9 (Group Number 05879)

  • Item 12 Attachment - Delta Dental Amendment No. 9 (Group Number 16128)

• Item 13 - Receive Update on Anthem Network Contracts with Trinity Health and UC Health

• Item 14 - Receive Recommendation of the Equitable Distribution of the Gallagher Settlement Funds Between the County of Fresno and the County of Tulare

• Item 15 - Receive Update on ARPA Funds Available to the SJVIA through the County of Fresno

• Item 16 - Director Questions, Announcements, and Activity Reports

• Item 17 - Adjourn

Consent Agenda

• Item 18 - Approval of Minutes - Board Meeting of August 25, 2023

• Item 19 - Approve Proposed 2024 Board Meeting Calendar

  • Item 19 Attachment - Proposed 2024 Board Meeting Calendar

• Item 20 - Approve Amendment No. 3 to Agreement with EmpiRx Health to Continue to Provide Pharmacy Benefit Management Services and Authorize President to Execute Amended Agreement Subject to Approval of SJVIA Counsel and Staff

  • Item 20 Attachment - Amendment No. 3 to Agreement with EmpiRx Health

• Item 21 - Approve and Authorize President to Execute SJVIA Agreement with Keenan Pharmacy Services (KPS) to Continue to Provide Pharmacy-Related Consulting Services Overseeing the SJVIA's Pharmacy Benefit Manager (PBM), EmpiRx, For a One-Year Term

  • Item 21 Attachment - Agreement with KPS

• Item 22 - Approve Update to Agreement with SJVIA's Stop Loss Carrier, Granular Life Insurance Company, to Change the Cost Containment Vendor from Point6 Healthcare to Sigmatico Effective July 1, 2023

  • Item 22 Attachment - Letter of Explanation of Change of Cost Containment Vendor

  • Item 22 Attachment - Granular Letter of Change of Cost Containment Vendor

  • Item 22 Attachment - Update to Agreement with SJVIA's Stop Loss Carrier, Granular Life Insurance Company

• Item 23 - Approve Amendment No. 3 to Agreement with Transcarent to Provide Mobile Phone App-Based Telemedicine Servics for an Additional Two-Year Term and Authorize President to Execute Amended Agreement

  • Item 23 Attachment - Amendment No. 3 to Agreement with Transcarent

• Item 24 - Approve and Authorize President to Execute SJVIA Participation Agreements for the County of Fresno, Effective December 11, 2023, and teh County of Tulare, Effective January 1, 2024

  • Item 24 Attachment - Plan Year 2024 County of Fresno SJVIA Participation Agreement

  • Item 24 Attachment - Plan Year 2024 County of Fresno SJVIA Participation Agreement - Exhibit A

  • Item 24 Attachment - Plan Year 2024 County of Fresno SJVIA Participation Agreement - Exhibit B

  • Item 24 Attachment - Plan Year 2024 County of Tulare SJVIA Participation Agreement

  • Item 24 Attachment - Plan Year 2024 County of Tulare SJVIA Participation Agreement - Exhibit A

  • Item 24 Attachment - Plan Year 2024 County of Tulare SJVIA Participation Agreement - Exhibit B

• Item 25 - Approve and Authorize President to Execute Amendment No. 1 to Agreement with Alinea Medical Imaging to Include SJVIA Members Enrolled in Kaiser Permanente to be Eligible for Mammography Services, Effective December 8, 2023

  • Item 25 Attachment - Amendment No. 1 to Agreement with Alinea Medical Imaging