Aetna Plan & Rate Updates Effective October 2023
Aetna announced plan and rate updates for October 1, 2023 effective dates. Rates are available for quoting!
Rates
Quarterly medical rate change (may vary by plan, region or network)
- OAMC/PPO: 4.1%
- HMO: 2.5%
Dental rates will be changing as well.
2023 broker bonus for both Affordable Care Act (ACA) and Aetna Funding Advantage
The bonus payout is based on the total number of enrolled employees for all the groups during 2023 to maximize your bonus potential. Want to know how close you are to your next bonus level? Contact your Aetna sales executive to find out your current tier status.
Click here to view Aetna's 2023 program flyer.
Bundle up and save more with Small Group
New and renewing groups get a premium credit when you offer dental to your groups.
**Only available to groups located in CA. Credit is based on number of enrolled subscribers and only applied once. Credit will appear on the third invoice from the group’s effective date.
Why bundle?
- Increased member engagement
- More identification of at-risk members
- Increased participation in care
- Simplified administration — consolidated invoice and one contact for health, dental and vision products.
Updates
Producer World
Producer World is your go-to website for information and to locate the most current underwriting guidelines, plan guide, SBCs, forms and much more! It’s available 24 hours a day, seven days a week, and is user-friendly.
Pharmacy
Effective July 1, 2023, Aetna made pharmacy drug changes to their 2023 Aetna Health Exchange Plan, Small Group California formulary. The Aetna Health Exchange plan – Small Group formulary will now be separated in to two separate formularies – California HMO and California OAMC/PPO.
View Aetna's formulary online and obtain copies of the updated formularies
Teladoc* convenient care for short-term health needs
When members need treatment for a short-term illness, it’s easy to connect with a doctor by phone or video and get care today. So they feel better, sooner. Aetna Small Group HMO and OAMC/PPO members have a $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
* Telehealth services may be available with your PCP or Specialist. If you use services from Teladoc, your medical records will be shared with your PCP or Specialist. If you want to opt-out, please notify Teladoc during your visit. In-network cost sharing will apply for all services received through Teladoc and will all out-of-pocket costs will accrue to the applicable deductible and/or out-of-pocket maximum.
MinuteClinic® services at no cost/low cost**
MinuteClinic helps make it easy for your members to get the care they need, when and where they need it. Your employees can get access to covered MinuteClinic services at no extra cost* to them – not just preventive care.* Learn how Aetna is connecting members to more health services, one-on-one guidance and total health resources.
- New — Aetna HMO members pay $0 copay
- Aetna OAMC members pay $0* copay
Includes MinuteClinic Virtual Care™ services at no extra cost across all plans.
Find a MinuteClinic location near you or view the MinuteClinic sell sheet.
**Aetna OAMC members on HSA plans receive $0 copay after deductible is met.
Giving your members access to immunizations under the pharmacy benefit
The seasonal vaccine program under pharmacy benefits gives members access to convenient immunization at pharmacies. The Public Health Emergency expired May 11th, 2023, but many pharmacies still have ample supply of the government funded COVID-19 vaccines. Once these supplies are exhausted, members will be responsible in providing insurance when getting a COVID-19 vaccine. Members can only receive coverage at a pharmacy if they have the seasonal vaccine benefit under their pharmacy or medical plan.
Previous years have shown that members with vaccine coverage only elected under their medical plan have encountered difficulties at a pharmacy when trying to receive coverage under their pharmacy plan. By having the vaccine program under both your medical and pharmacy plan, it will create a seamless member journey at either a provider’s office or pharmacy location.
To ensure that all members have a seamless member journey when receiving a flu, COVID-19, or other seasonal vaccines this year, Aetna is adding the seasonal vaccine coverage to your pharmacy plan starting September 1st, 2023.
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.