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Aetna Plan & Rate Updates Effective January 2023

Oct 06, 2022

Aetna announced ​plan and rate updates for January 1, 2023 effective dates. Rates are available for quoting!

 

Rates

Quarterly medical rate change (may vary by plan, region or network)

  • OAMC/PPO: 1.6%
  • HMO: 0.8%

 

Dental rates will be changing effective January 1, 2023. There are no changes for vision rates at this time.

 

2023 Network Updates

New Aetna Whole Health Northern California Network

Aetna is introducing the Aetna Whole Health Northern California network in 2023, available in Alameda, Contra Costa, Fresno, Marin, Sacramento, San Francisco, San Joaquin, Santa Clara, and Stanislaus counties. This new network in California will be 6% less expensive (savings vary by rating area) than the full network HMO while still offering access to some of the regions most desirable providers. Overall, the network includes:

  • 1,700+ primary care doctors
  • 5,200+ specialists
  • 33 hospitals
  • 13 retail clinics
  • 250+ urgent care centers

 

The network includes the following in-network IPAs: 

  • Hill Physicians - East Bay - Alameda
  • Hill Physicians - East Bay - Contra Costa
  • John Muir Physician Network
  • Sante Physicians
  • Meritage Medical Network
  • Hill Physicians - Sacramento
  • All American Medical Group (formerly Asian American Medical Group)
  • Hill Physicians - San Francisco
  • Hill Physicians - San Joaquin
  • SCCIPA (IPA Medical Group of Santa Clara County)
  • Hill Physicians Medical Group (Stanislaus County)

 

AWH members must enroll in the AWH plan where they reside. For example, employees in Northern California would need to enroll in the AWH Northern California plan, whereas Southern California members would enroll in the AWH Southern California plans. There is no crossover between networks. Both plans would count towards the 10 plans an employer can offer.

 

Portfolio Updates

Plan Changes

Aetna is adding 3 new PPO plans to their portfolio, giving more options to employees requiring the PPO network instead of the OAMC network:

  • PPO Silver 60/50 2100
  • PPO Bronze 55/50 4600
  • PPO Bronze 55/50 8300

 

Aetna is discontinuing the Silver OAMC 60/50/1700 plan.

 

2023 Plan Count

  • 12 HMO plans
  • 14 OAMC plans
  • 4 PPO plans

 

Benefits

Plans may experience benefit changes.

  • HMO plans now include now cost MinuteClinic benefit
    • Includes Virtual MinuteClinic at no cost across all plans
  • $0 Teladoc copay for General Medicine and Dermatology for HMO and OAMC/PPO
    • Teladoc Behavioral Health to remain at in-person Mental Health Office Visit copay
    • State mandated "M" plans and matching "wINF" plans excluded
  • All plans cover state mandated infertility preservation services. Plans referencing "wINF" in the plan name include additional infertility services.
  • All plan cover acupuncture.
  • All non-mandated plans include chiropractic care.
  • “M” within the plan name indicates mandated plans.

 

Pharmacy 

2023 Formulary is the Aetna Health Exchange Plan - Small Group

 

Underwriting Updates

  • Relaxed participation promotion: Groups with minimum 5 enrolled only need 25% participation.
  • DEC9C not required with 5 or more subscribers enrolling.
  • Pick 10: New and renewing groups can select up to 10 plans. No need to worry about which networks you can sell together. Aetna offers any combination of plans under Pick 10.

 

Attain by Aetna

The Attain app is now available at no additional cost for all small group medical plans for any member age 18 and over. Members can use their own Apple Watch or Fitbit. The program is also available for Android members where they can earn gift cards (instead of an Apple Watch).

 

Book Rates

Book rates for Aetna will be provided on the B&P website when they are available.

 

For questions, please contact a member of your B&P Sales Team - 888.722.3373.

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