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51-125: Benefit Changes for New & Renewing Groups Effective October
Jul 08, 2010
Important changes to California health benefits plans
Aetna would like to inform you about upcoming changes for new and renewing groups with 51-125 eligible employees.
*** COMPLIANT SUMMARIES AVAILABLE AT B&P - CONTACT THE LARGE GROUP TEAM AT 888.722.3373.***
Overview of upcoming changes
- Aetna is changing their health benefits plan designs to comply with new federal laws.
- Aetna is making it easier for your clients to choose plan designs by simplifying the plan designs that we make available.
- Aetna is making other changes to better manage rising health care costs.
How Aetna’s plans will change
Here are some important changes /Aetna is making to many Aetna plan designs:
- Dependent children can now enroll in an Aetna plan up to age 26. If state law requires coverage of dependents age 26 and older, the plan will continue to cover those dependents.
- Coverage for enrollees up to age 19 will include services needed to treat pre-existing conditions.
- Plan designs will have no overall dollar limit on how much Aetna will pay over a member’s lifetime.
- Aetna members won’t pay anything for certain preventive care delivered from network providers.
- In some states, plans will require members to pay more if they choose to get care outside of Aetna’s network. Members can choose from Aetna’s broad network, and avoid extra costs, by visiting Aetna's online directory, DocFind®, at www.aetna.com/docfind.
These changes are part of Aetna's continuing effort to provide your clients access to high-quality, affordable health coverage. Changes in plan designs may result in reduced coverage for some services. Also, some of these provisions may already be included in your clients’ plan designs. Aetna recommends you and your clients carefully review their plan documentation to understand which of these changes may apply to their plans.
Aetna will offer a stream-lined portfolio of plans
As of October 1, 2010, Aetna will offer a stream-lined portfoilio of plan designs, allowing them to serve your clients more efficiently and simplify their plan choices. This streamlined portfolio of products will give your customers the ability to select from different plan designs at a variety of price points. You will also see improvements in the timeliness and accuracy of the administrative processes.
What to expect
- In-force customer plan design(s) will stay in effect until current policy periods end. At that time, they will renew into the new portfolio of products in the plan design that best meets the needs of their employees.
- Aetna will send a renewal packet before the current plan period ends. At that time, if your clients currently offer one or more of the benefits plan designs Aetna will no longer be offering, they will provide information on the alternative plan design that most closely resembles the in-force plan design as well as other Aetna plan designs that are available.
- If Aetna does not hear from existing plan sponsors 30 days prior to their renewal date, they will automatically switch them to the Aetna plan design that we believe most closely matches their existing plan.
You should also be aware that the Federal government recently released regulations related to grandfathering of health plans in existence on March 23, 2010. Changes in benefit design and contribution strategy may affect grandfathering. Renewal offerings may not preserve grandfathering.
Plan Sponsor notification
Depending on state regulations, Aetna will notify current plan sponsors of these changes in one of two ways:
- A letter mailed 90 days prior to the renewal date
- A renewal package sent 60 days prior to the renewal date with the embedded change