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2-50: February 2010 Rate Change & Other News

Dec 29, 2009

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Aetna Small Group
February 2010 Rate Change & Other News
Aetna Small Group has announced that they will not be making changes to their plan portfolio for February 1, 2010 effective dates. There will, however, be a rate change.

And don't forget that the HSA Open Window is also available for a February 1, 2010 effective date and the revised RAF Guarantee Program is available through April 15, 2010. Read on for those details and network updates.

  • Medical rates will increase February 1, 2010.
  • Rating Area Change: zipcodes beginning 901, 903 and 905 have been moved from Region 4 to Region 3.
  • Click here to view rates.
  • Dental rates will increase February 1, 2010.
  • Click here to view rates
Life and Disability
  • Life and Disability rates have been extended through March 31, 2010.
Aetna's revised RAF promotion is available for January 1 - April 15, 2010 effective dates.
  • .90 RAF: 10-50 CA medically enrolling employees
  • Click here for Aetna's current RAF promotion
Guidelines (changes from current RAF promotion in bold blue):
  • Groups must submit a copy of their 'original' current AND prior renewal or their issued RAF at new business.
  • Aetna will only accept the original renewal received by a group to determine eligibility; revised renewals will not be accepted.
  • Groups applying for the guaranteed RAF must be AB1672 eligible and have a current RAF of 1.06 or less with their current carrier.
  • Groups must apply for the RAF promotion prior to final underwriting approval.
  • AB1672 eligible groups moving from a large group contract are eligible if the group provides a large group renewal of less than 20% increase within 90 days of their requested effective date.
  • Groups that received a 10-point RAF increase are ineligible.
  • Groups with 30% or more COBRA/Cal-COBRA enrollees are ineligble.
  • COBRA/Cal-COBRA enrollees do not count toward enrolled employee counts.
  • Groups moving from CaliforniaChoice, Contractor's Choice, HSA California, Kaiser Permanente Choice Solution and/or groups that have withdrawn from Aetna within 12 months of the requested date are ineligible.
  • Carve out groups (management / non-management, union / non-union) are ineligible.
Your clients may choose to offer employees currently enrolled in an Aetna Small Group plan the option to enroll in an HSA-compatible plan for a January or February 2010 effective date. Change requests may be submitted as early as December 1 through January 31, 2010.
Requesting an Effective Date:
  • Groups whose current effective date falls on the 1st of the month must choose the 1st of the month as the new effective date.
  • Groups whose current effective date falls on the 15th of month must choose the 15th of the month as the new effective date.
Application Timetable:
  • Applications received between December 1 - December 31, 2009 will receive a January effective date.
  • Applications received between January 1 - January 31, 2010 will receive a February effective date. 
Submitting the Change Request:
Network Updates
Northern California
George L. Mee Memorial Hospital has been added to Aetna's MC and PPO network effective November 15, 2009. George L. Mee Memorial Hospital is located in Kings City, CA (Southern Monterey County).

Central Valley

Effective December 1, 2009, the HMO and HMO HRA Network service area is expanding in the following counties (partial): Kings, Nevada, Tulare, and Madera (additional zip codes added to existing HMO county). This service area expansion adds 14 hospitals to the Central Valley HMO service area.  Click here to view the list of facilities

Biggs-Gridley Memorial Hospital in Gridley, CA, will be terminating from Aetna's MC and PPO networks. This termination will be effective February 17, 2010. An alternate hospital in the immediate area is Oroville Hospital located in Oroville, CA.

Southern California - Value Network
The Aetna Value Network will have the following changes, effective January 1, 2010: 
  • Additions (Los Angeles County): Seoul Medical Group, Applecare - Select, and Applecare - Whittier
  • Terminations (Los Angeles County): Applecare Medical Group - Downey
  • Terminations (San Bernardino County): United Family Care
Affected members are sent written notifications advising them that their PCP will no longer be available through the AVN network.  Members are being directed to Aetna Member Services to select a new PCP, and to address any potential Transition of Care issues.

Southern California
Lakeside Medical Group and Lakeside Affiliated Groups merged into Health Physician Network, effective November 1, 2009. The new names are:
  • Heritage Physician Network - Lakeside Burbank
  • Heritage Physician Network - Lakeside Central Valley
  • Heritage Physician Network - Lakeside North Valley
  • Heritage Physician Network - Lakeside Santa Clarita
  • Heritage Physician Network - Lakeside Glendale
  • Heritage Physician Network - Community Medical Group
  • Heritage Physician Network - Eastland Medical Group
  • Heritage Physician Network - Verdugo Hills Medical Group
  • Heritage Physician Network - West Covina Medical Clinic
There will be no interruption of services for current members during this transition. For new members previously unable to select a PCP from Lakeside Medical Group or Lakeside Affiliated Group, the PCP panels will be reopened when the groups are moved under the new Heritage Physician Network, which may take a few weeks to complete.

La Vida Medical Group & IPA
Effective December 2, 2009, the Department of Managed Health Care has issued a Cease & Desist Order requiring Aetna and all other health plans to immediately stop assigning any new enrollees to any of the LaVida groups. LaVida Medical Group & IPA consists of LaVida Medical Center - Civic Center, LaVida Medical Center - Fox Hills, LaVida Medical Center - Gardena, LaVida Medical Center - Grand, LaVida Medical Center - San Pedro and LaVida Prairie Medical Center. LaVida members through other health plans, who are switching their coverage to Aetna, must select a PCP who is affiliated with an alternate IPA/Medical Group.
Sansum Clinic Behavioral Health in Santa Barbara will terminate from Aetna's Behavioral Health network for the HMO, QPOS and HMO/HRA effective January 1, 2010. This was an interim agreement to allow Sansum providers to render outpatient behavioral health services to HMO members through December 31, 2009. Aetna Behavioral Health maintains an agreement with College Health IPA to provide outpatient behavioral health services to HMO members in Santa Barbara County.
Please contact any member of your B&P Sales Team for assistance with quote requests and questions regarding the details above.
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