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2-50: January Updates - Plan Changes, New RAF Program, Open Window...

Nov 18, 2009

Aetna Small Group
HSA Open Window, New RAF Program & More Combined Deductibles
Aetna Small Group has announced great news for January 1, 2009 effective dates. They will be offering an HSA Open Enrollment, a revised RAF Guarantee Program and more plans with combined deductibles. Read on for the details.

MC HSA $2300 80/50 Plan
The HSA $2300 plan will change to a $2500 deductible, combined for both in and out of network. The change in the deductible to $2500 is required to maintain compatibility under the HSA guidelines for 2010. There will be no rate change to the plan as a result of these changes.

More Plans With Combined Deductibles
Aetna Small Group has improved their plan designs to include more options in their portfolio with combined deductibles. Effective for January 1, 2010 effective dates, eight (8) small group plan designs will offer combined deductibles to maximize benefits for subscribers. 
New Combined Deductible Plans Effective January 1, 20101
  • MC $1000 70/50
  • MC HSA $2500 80/50 (formerly $2300 plan)2
  • MC HSA $3300 80/50
  • MC HRA HDHP $3000 80/50
Plans Already With Combined Deductibles
  • MC $750 80/50/50
  • MC $2500 75/50
  • MC $10000
  • PPO $750 80/50

1 - Combined deductible will be effective for new business as of January 1, 2010. All members enrolled in these plans as of December 31, 2009 will have a combined in and out-of-network benefit as of January 1, 2010 regardless of their effective date.  

2 - Increased deductible for HSA $2300 80/50 plan to $2500 80/50 plan takes effect as of January 1, 2010 group renewals to ensure the HSA meets Federal guidelines. Members will move to the new plan on their renewal date after January 1, 2010.
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:
Aetna has revised their RAF promotion guidelines for effective dates January 1, 2010 - April 15, 2010.
  • .90 RAF: 10-50 CA medically enrolling employees
  • Click here for Aetna's current RAF promotion
Guidelines (changes from current RAF promotion in bold):
  • 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, uion / non-union) are ineligible.
Clients and members often wonder how they go about receiving credit for money paid toward their prior carrier's plan deductible. Details are provided below.
  • A request to receive prior carrier deductible credit can be included with the group's initial submission. Underwriting will process through claims.  Important: Please be sure to include member's date of birth and Social Security Number (SSN) on the prior carrier's Explanation of Benefits (EOB).
  • Aetna Small Group will send letters to employers and employees on the availability of prior carrier deductible credit at the close of a month's new business processing.
These letters will provide details on how a member may submit the letter along with their most recent EOB from their prior carrier to obtain credit.  The attached letter should be used to submit deductible credit for newly enrolled groups that did not submit during initial submission.  Processing time for completion of these requests is five (5) business days. Members can follow up with Member Services at 888.802.3862. 
  • For employers with 11 or more employees requesting prior carrier deductible credit, please contact a member of your b&p Sales Team for instructions on how to submit multiple requests from the employer.
Network Updates
Vitalidad Plus
Effective January 1, 2010, Aetna will have a Vitalidad Plus network that allows members to select providers for care in the United States or Mexico. This network and products will be rolled out in Small Group May 1, 2010. The network and plans will be effective in Mid-Market effective May 1, 2010.

Northern California

UCSF Medical Group and Hills Physician Medical Group has formed a new affiliation to provide primary and specialty health services for HMO members in San Francisco area.  This new affiliation is effective January 1, 2010.  With this new affiliation UCSF's relationship with Brown & Toland ends.  For Aetna HMO members, there is no change to their primary care physician or hospital access.

Monterey Peninsula Surgery Center has a new contract for Aetna's MC/PPO network in Monterey that was effective October 1, 2009.

Southern California
CLOSED PANEL NOTICE: The Department of Managed Health Care (DMHC) has served a Cease & Desist Order that requires Aetna to immediately stop assigning or adding any additional enrollees to Lakeside Medical Group (Burbank/N. Hollywood, Central Valley, Glendale, North Valley & Santa Clarita Valley), effective October 1, 2009. 

Affiliated Group also served this order to include Community Medical Group of the West Valley, Eastland Medical Group and West Covina Medical Clinic, effective October 15, 2009.  Current Aetna membership in these medical groups may remain assigned to their PCPs. Aetna will provide any updates to the re-opening of the panel as they become available.
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