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2-50: January 2011 Rate Change, HSA Open Window, etc.

Nov 10, 2010

Aetna Small Group
HSA Open Window, New RAF Program & More Combined Deductibles

Aetna Small Group has announced their January 1, 2011 rate increases as well as an HSA Open Window, a revised RAF Guarantee Program and more. Read on for the details.
 
ratesRATE ADJUSTMENTS (effective January 1, 2011)
 
HMO Plans:
  • Northern CA: 0.8%
    Southern CA: 0.8%
Advantage Value Network (AVN) Plans:
  • Northern CA: 0.8%
  • Southern CA: 2.2%
Managed Choice (MC) Plans:
  • Northern CA: 3.3%
  • Southern CA: 0.2%
Plan Specific Changes:
  • HMO Deductible: -10.0% (Rating Areas 1, 2, 3, 4, 5)
  • MC HSA 3500 80/50: -10.0% (All Rating Areas)
  • MC 1000 80/50/50: +5.0% (All Rating Areas)
  • MC 2500 75/50: -7.0% (Rating Area 1) & -5.0% (Rating Area 3)
  • MC HRA 3000 80/50: -5.0% (Rating Area 8)
Rating Area Changes:
San Francisco will move from Rating Area 8 to Rating Area 7
 
openwindowHSA OPEN ENROLLMENT
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 2011 effective date. Change requests may be submitted as early as December 1 through January 31, 2011.

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, 2010 will receive a January effective date.
  • Applications received between January 1-January 31, 2011 will receive a February effective date.
Eligible Plans:
  • Click here to view eligible plans and any employer or employee restrictions.
  • Please note that eligible plans are based on the groups current renewal.
Applications received between January 1-January 31, 2011 will receive a February effective date. 

 

Submitting the Change Request:

 

 

 
rafpromoRAF PROMOTION EFFECTIVE JANUARY 1, 2011
Aetna has revised their RAF promotion guidelines for effective dates January 1, 2011 - June 15, 2011.
  • .90 RAF: 15-50 CA medically enrolling employees
  • .92 RAF: 10-14 CA medically enrolling employees
  • Click here
     for Aetna's current RAF promotion
Guidelines:
  • 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) and PEO groups are ineligible.
 
healtfundHEALTHFUND HRA - SETUP FEES WAIVED JANUARY 2011
For January 2011 new business, employer set up fees for HRA administration will be waived. This saves employers:
  • $350 for 2-25 groups
  • $450 for 26-50 groups
  • Monthly administrative fee of $5 per participant remain in place.

Key Benefits of Aetna HealthFund HRA:

  • Employer does not have to pre-fund the HRA account!
  • Reimbursement for employees is streamlined.
  • No need for employees to submit claims for reimbursement!
 
Network Updates
Northern California
Aetna's contract with Community Hospital of Monterey Peninsula will terminate on December 31, 2010 from the Northern California Aetna network.  Click here for the broker communication with details of the termination.

Mills Peninsula Medical Group was recently purchased by Palo Alto Medical Foundation (PAMF), a Sutter affiliate.  Sutter notified Aetna which physicians will no longer be covered by the HMO arrangement.  There are a large number of physicians that Sutter indicated were not going to be part of PAMF.  Aetna has sent notices to members assigned/treated by those physicians indicating their physician is no longer part of the Aetna HMO network and would be reassigned to a participating physician.  At this time, ALL physicians that were part of Mills Peninsula Medical Group for HMO will be part of PAMF.  Members displaced from the Mills Peninsula providers will be moved back to their PCP.

Southern California
The previously announced termination of Huntington Memorial Hospital in Pasadena, CA has been rescinded.  There has been no interruption to member access since agreement was reached prior to the provider's termination date.
Central Valley
Negotiations completed for Community Medical Centers which includes Community Regional Medical Center, Clovis Medical Center and Fresno Heart & Surgical Hospital located in Fresno, CA.  There was no access disruption for Aetna members.
 
Fresno Surgical Hospital located in Fresno, CA will terminate from Aetna's Central Valley network effective December 1, 2010.  There will be no physician impact as a result of this termination.  Alternative hospitals include:  St. Agnes Medical Center, Fresno Heart Hospital, Community Medical Centers.
 
Please contact any member of your b&p Sales Team for assistance with quote requests and questions regarding the details above.

Sincerely,
beere&purves
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